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Yu HK, Chen CY, Chen YC, Cheng CH, Chen CY, Hu GC. Effect of Cardiac Rehabilitation on Cardiorespiratory Fitness in Patients With Acute Myocardial Infarction: Role of Diabetes Mellitus and Glycated Hemoglobin Level. J Cardiopulm Rehabil Prev 2024; 44:311-316. [PMID: 39230352 DOI: 10.1097/hcr.0000000000000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
PURPOSE Following acute myocardial infarction (AMI), patients with diabetes mellitus (DM) have a poorer prognosis than those without DM. This study aimed to investigate the benefit of cardiac rehabilitation on cardiorespiratory fitness in patients with AMI, examining whether this effect varied depending on DM and glycated hemoglobin (HbA1c) levels. METHODS Data were collected from the medical records of 324 patients diagnosed with AMI who were subsequently referred to participate in a supervised exercise-based cardiac rehabilitation program. Cardiorespiratory fitness was assessed using cardiopulmonary exercise testing before and at 3 and 6 mo after the start of cardiac rehabilitation. Linear mixed models were used to evaluate changes in cardiorespiratory fitness between patients with and without DM during the follow-up period. RESULTS In total, 106 patients (33%) had DM. Both patients with and without DM showed a significant improvement in cardiorespiratory fitness from baseline to the 6-mo follow-up. However, the improvement was significantly lower in patients with DM than in those without DM (1.9 ± 1.5 vs. 3.7 ± 3.2 mL/kg/min, P < .001). Among patients with DM, those with HbA1c levels < 7% showed a greater improvement in cardiorespiratory fitness than those with HbA1c ≥ 7% (2.7 ± 1.5 vs. 1.1 ± 1.8 mL/kg/min, P < .001) during the follow-up period. CONCLUSIONS Improvements in cardiorespiratory fitness following cardiac rehabilitation were significantly lower in patients with AMI and DM. The response to cardiac rehabilitation in patients is influenced by HbA1c levels. These findings suggest potential implications for individualizing cardiac rehabilitation programming and ensuring optimal glycemic control in patients with AMI and DM.
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Affiliation(s)
- Hui-Kung Yu
- Author Affiliations: Department of Nursing (Ms Yu), Institute of Clinical Nursing (Dr Y-C Chen), College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan; and Cardiovascular Division, Department of Internal Medicine (Dr Chun-Yen Chen), Mackay Medical College, Department of Medicine (Drs Chun-Yen Chen and Hu), Department of Rehabilitation Medicine (Drs Cheng, Chi-Yen Chen, and Hu), Mackay Memorial Hospital, Taipei, Taiwan
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White L, Kirwan M, Christie V, Hurst L, Gwynne K. The Effectiveness of Clinician-Led Community-Based Group Exercise Interventions on Health Outcomes in Adults with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:601. [PMID: 38791815 PMCID: PMC11120654 DOI: 10.3390/ijerph21050601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/03/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024]
Abstract
This systematic review and meta-analysis evaluated the combined effects of clinician-led and community-based group exercise interventions on a range of health outcomes in adults with type 2 diabetes mellitus. Our literature search spanned Medline, Scopus, PubMed, Embase, and CINAHL databases, focusing on peer-reviewed studies published between January 2003 and January 2023. We included studies involving participants aged 18 years and older and articles published in English, resulting in a dataset of eight studies with 938 participants. Spanning eight peer-reviewed studies with 938 participants, the analysis focused on the interventions' impact on glycemic control, physical fitness, and anthropometric and hematological measurements. Outcomes related to physical fitness, assessed through the six-minute walk test, the 30 s sit-to-stand test, and the chair sit-and-reach test, were extracted from five studies, all of which reported improvements. Anthropometric outcomes from seven studies highlighted positive changes in waist circumference and diastolic blood pressure; however, measures such as body mass index, systolic blood pressure, weight, and resting heart rate did not exhibit significant changes. Hematological outcomes, reviewed in four studies, showed significant improvements in fasting blood glucose, triglycerides, and total cholesterol, with glycemic control evidenced by reductions in HbA1c levels, yet LDL and HDL cholesterol levels remained unaffected. Ten of the fifteen outcome measures assessed showed significant enhancement, indicating that the intervention strategies implemented may offer substantial health benefits for managing key type 2 diabetes mellitus-related health parameters. These findings in combination with further research, could inform the refinement of physical activity guidelines for individuals with type 2 diabetes mellitus, advocating for supervised group exercise in community settings.
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Affiliation(s)
- Liam White
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Talavera Road, North Ryde, NSW 2109, Australia; (L.W.); (M.K.); (L.H.)
| | - Morwenna Kirwan
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Talavera Road, North Ryde, NSW 2109, Australia; (L.W.); (M.K.); (L.H.)
| | - Vita Christie
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research, Heart Research Institute, Eliza Street, Newtown, NSW 2042, Australia;
- DVC Indigenous Office, University of New South Wales, High Street, Sydney, NSW 2052, Australia
| | - Lauren Hurst
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Talavera Road, North Ryde, NSW 2109, Australia; (L.W.); (M.K.); (L.H.)
| | - Kylie Gwynne
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research, Heart Research Institute, Eliza Street, Newtown, NSW 2042, Australia;
- DVC Indigenous Office, University of New South Wales, High Street, Sydney, NSW 2052, Australia
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Jlali I, Touil I, Ibn Haj Amor H, Bouzid MA, Hammouda O, Heyman E, Fontaine P, Chtourou H, Rabasa-Lhoret R, Baquet G, Tagougui S. Impaired muscle oxygenation despite normal pulmonary function in type 2 diabetes without complications. Am J Physiol Endocrinol Metab 2024; 326:E640-E647. [PMID: 38536038 DOI: 10.1152/ajpendo.00392.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 05/01/2024]
Abstract
Long-term hyperglycemia in individuals with type 2 diabetes (T2D) can detrimentally impact pulmonary function and muscle oxygenation. As a result, these factors can impede the body's adaptation to physical exertion. We aimed to evaluate the oxygen pathway during maximal exercise among overweight/obese individuals with type 2 diabetes free from complications, in comparison with a group of matched overweight/obese individuals without diabetes, specifically concentrating on the effects on pulmonary function and muscle oxygenation. Fifteen overweight/obese adults with type 2 diabetes [glycated hemoglobin (HbA1c) = 8.3 ± 1.2%] and 15 matched overweight/obese adults without diabetes underwent pre- and post exercise lung function assessment. A maximal incremental exercise test was conducted, monitoring muscle oxygenation using near-infrared spectroscopy and collecting arterial blood gas samples. Both groups exhibited normal lung volumes at rest and after exercise. Spirometric lung function did not significantly differ pre- and post exercise in either group. During maximal exercise, the type 2 diabetes group showed significantly lower augmentation in total hemoglobin and deoxygenated hemoglobin compared with the control group. Despite comparable usual physical activity levels and comparable heart rates at exhaustion, the type 2 diabetes group had a lower peak oxygen consumption than controls. No significant differences were found in arterial blood gas analyses ([Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text]) between the groups. Individuals with type 2 diabetes free from complications displayed normal pulmonary function at rest and post exercise. However, impaired skeletal muscle oxygenation during exercise, resulting from reduced limb blood volume and altered muscle deoxygenation, may contribute to the lower V̇o2peak observed in this population.NEW & NOTEWORTHY Individuals with type 2 diabetes free from micro- and macrovascular complications have normal resting pulmonary function, but their V̇o2peak is impaired due to poor skeletal muscle oxygenation during exercise. Tailoring exercise regimes for this population should prioritize interventions aimed at enhancing muscle oxygenation and blood flow improvement.
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Affiliation(s)
- Islem Jlali
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Imen Touil
- Pulmonology Department, Taher Sfar Hospital, Mahdia, Tunisia
| | | | - Mohamed Amine Bouzid
- UR15JS01: Education, Motricité, Sport et Santé (EM2S), High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
| | - Omar Hammouda
- Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS, UPL, Paris Nanterre University, Nanterre, France
| | - Elsa Heyman
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
- Institut Universitaire de France (IUF), Paris, France
| | - Pierre Fontaine
- Department of Diabetology, University Hospital, Lille, France
| | - Hamdi Chtourou
- Higher Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
- Physical Activity, Sport, and Health, UR18JS01, National Observatory of Sport, Tunis, Tunisia
| | | | - Georges Baquet
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Sémah Tagougui
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
- Montreal Clinical Research Institute, Montreal, Quebec, Canada
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Gao K, Su Z, Meng J, Yao Y, Li L, Su Y, Mohammad Rahimi GR. Effect of Exercise Training on Some Anti-Inflammatory Adipokines, High Sensitivity C-Reactive Protein, and Clinical Outcomes in Sedentary Adults With Metabolic Syndrome. Biol Res Nurs 2024; 26:125-138. [PMID: 37579279 DOI: 10.1177/10998004231195541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
OBJECTIVE This study aimed to investigate the effects of aerobic interval training and resistance training on anti-inflammatory adipokines, high sensitivity C-reactive protein, and clinical outcomes in sedentary men with metabolic syndrome. METHODS A total of 33 sedentary men with metabolic syndrome (age: 46.2 ± 4.6 years; body mass index: 35.4 ± 1.9 kg.m2) were randomly assigned to one of 3 groups: aerobic interval training (n = 12), resistance training (n = 10), or control (n = 11). Participants in the exercise groups completed a 12-week training program, 3 sessions per week, while those in the control group maintained their sedentary lifestyle. The levels of high sensitivity C-reactive protein (hs-CRP), omentin-1, adiponectin, lipid profiles, blood pressure, glucose metabolism, body composition, and peak oxygen uptake (VO2peak) were measured at baseline and after the intervention. RESULTS Both aerobic interval training and resistance training significantly improved the levels of omentin-1 and adiponectin, as well as reduced inflammation, as indicated by a decrease in hs-CRP levels. Exercise training also led to significant improvements in lipid profiles, blood pressure, glucose metabolism, and body composition. Specifically, the aerobic interval training group had significantly greater increases in high-density lipoprotein cholesterol and VO2peak, as well as greater reductions in low-density lipoprotein cholesterol, triglycerides, and total cholesterol compared to the resistance training group. CONCLUSION Exercise training, particularly aerobic interval training and resistance training, can be an effective non-pharmacological intervention for managing inflammation and improving cardiovascular health in metabolic syndrome patients.
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Affiliation(s)
| | - Zhanguo Su
- Faculty of Physical Education, Huainan Normal University, Huainan, China
- International College, Krirk University, Bangkok, Thailand
| | - Junyan Meng
- Faculty of Physical Education, Huainan Normal University, Huainan, China
| | - Yuzhong Yao
- International College, Krirk University, Bangkok, Thailand
| | - LiGuang Li
- International College, Krirk University, Bangkok, Thailand
| | - Yiping Su
- Faculty of Mathematics and Science, Universitity Pendidikan Sultan Idris, Tanjong Malim, Malaysia
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Type 2 Diabetes Related Mitochondrial Defects in Peripheral Mononucleated Blood Cells from Overweight Postmenopausal Women. Biomedicines 2023; 11:biomedicines11010121. [PMID: 36672627 PMCID: PMC9855941 DOI: 10.3390/biomedicines11010121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/24/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023] Open
Abstract
Type 2 diabetes (T2D) is a multisystem disease that is the subject of many studies, but the earliest cause of the disease has yet to be elucidated. Mitochondrial impairment has been associated with diabetes in several tissues. To extend the association between T2D and mitochondrial impairment to blood cells, we investigated T2D-related changes in peripheral mononucleated blood cells’ (PBMCs) mitochondrial function in two groups of women (CTRL vs. T2D; mean age: 54.1 ± 3.8 vs. 60.9 ± 4.8; mean BMI 25.6 ± 5.2 vs. 30.0 ± 5), together with a panel of blood biomarkers, anthropometric measurements and physiological parameters (VO2max and strength tests). Dual-energy X-ray absorptiometry (DXA) scan analysis, cardio-pulmonary exercise test and blood biomarkers confirmed hallmarks of diabetes in the T2D group. Mitochondrial function assays performed with high resolution respirometry highlighted a significant reduction of mitochondrial respiration in the ADP-stimulated state (OXPHOS; −30%, p = 0.006) and maximal non-coupled respiration (ET; −30%, p = 0.004) in PBMCs samples from the T2D group. The total glutathione antioxidant pool (GSHt) was significantly reduced (−38%: p = 0.04) in plasma samples from the T2D group. The fraction of glycated hemoglobin (Hb1Ac) was positively associated with markers of inflammation (C-reactive protein-CRP r = 0.618; p = 0.006) and of dyslipidemia (triglycerides-TG r = 0.815; p < 0.0001). The same marker (Hb1Ac) was negatively associated with mitochondrial activity levels (OXPHOS r = −0.502; p = 0.034; ET r = −0.529; p = 0.024). The results obtained in overweight postmenopausal women from analysis of PBMCs mitochondrial respiration and their association with anthropometric and physiological parameters indicate that PBMC could represent a reliable model for studying T2D-related metabolic impairment and could be useful for testing the effectiveness of interventions targeting mitochondria.
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Huber J, Smeikal M, Saely CH, Stingl H, Clodi M, Lechleitner M, Fasching P. [Geriatric aspects for the management of diabetes mellitus (Update 2023)]. Wien Klin Wochenschr 2023; 135:307-318. [PMID: 37101051 PMCID: PMC10133361 DOI: 10.1007/s00508-022-02124-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 04/28/2023]
Abstract
There is a high prevalence of diabetes mellitus in the elderly population of industrial countries. The present article provides recommendations for the screening, prevention and treatment of elderly diabetic patients according to current scientific evidence.
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Affiliation(s)
- Joakim Huber
- Abteilung für Innere Medizin mit Akutgeriatrie und Palliativmedizin, Franziskus Spital, Standort Landstraße, Landstraßer Hauptstraße 4a, 1030 Wien, Österreich
| | - Michael Smeikal
- Abteilung für Innere Medizin mit allgemeiner Geriatrie und Palliativmedizin, Haus der Barmherzigkeit, Wien, Österreich
| | - Christoph H. Saely
- Abteilung für Innere Medizin und Kardiologie/VIVIT-Institut, Landeskrankenhaus Feldkirch, Feldkirch, Österreich
| | - Harald Stingl
- Interne Abteilung, Landesklinikum Melk, Melk, Österreich
| | - Martin Clodi
- ICMR—Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz (JKU Linz), 4040 Linz, Österreich
| | - Monika Lechleitner
- Interne Abteilung, Landeskrankenhaus Hochzirl – Natters, Hochzirl, Österreich
| | - Peter Fasching
- 5. Medizinische Abteilung mit Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring der Stadt Wien, Wien, Österreich
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Activity-related dyspnea in older adults participating in the Canadian Longitudinal Study on Aging. J Gen Intern Med 2022; 37:3302-3309. [PMID: 35819684 PMCID: PMC9550921 DOI: 10.1007/s11606-021-07374-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/17/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND Dyspnea is associated with functional impairment and impaired quality of life. There is limited information on the potential risk factors for dyspnea in an older adult population. OBJECTIVES Among older adults aged 45 to 85 years of age, what sociodemographic, environmental, and disease related factors are correlated with dyspnea? DESIGN We used cross-sectional questionnaire data collected on 28,854 participants of the Canadian Longitudinal Study of Aging (CLSA). Multinomial regression was used to assess the independent effect of individual variables adjusting for the other variables of interest. KEY RESULTS The adjusted odds ratios for dyspnea "walking on flat surfaces" were highest for obesity (OR, 5.71; 95%CI, 4.71-6.93), lung disease (OR, 3.91; 95%CI, 3.41-4.49), and depression (OR, 3.68; 95%CI, 3.15-4.29), and were greater than 2 for lower income, and heart disease. The effect of diabetes remained significant after adjusting for sociodemographics, heart disease and BMI (OR, 1.61; 95%CI, 1.39-1.86). Those with both respiratory disease and depression had a 12.78-fold (95%CI, 10.09-16.19) increased odds of exertional dyspnea, while the corresponding OR for the combination of heart disease and depression was 18.31 (95%CI, 13.4-25.01). CONCLUSIONS In a community sample of older adults, many correlates of dyspnea exist which have significant independent and combined effects. These factors should be considered in the clinical context where dyspnea is out of proportion to the degree of heart and lung disease. Whether or not diabetes may possibly be a risk factor for dyspnea merits further investigation.
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Chen J, Wang X, Dong B, Liu C, Zhao J, Dong Y, Liang W, Huang H. Cardiac function and exercise capacity in patients with metabolic syndrome: A cross-sectional study. Front Cardiovasc Med 2022; 9:974802. [PMID: 36035938 PMCID: PMC9410700 DOI: 10.3389/fcvm.2022.974802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMetabolic syndrome is a pre-diabetes condition that is associated with increased cardiovascular morbidity and mortality. We aimed to explore how exercise capacity, cardiac structure, and function were affected in patients with metabolic syndrome.MethodsOutpatients with echocardiography and exercise stress test combined with impedance cardiography (ETT + ICGG) results available from Nov 2018 to Oct 2020 were retrospectively enrolled. Echocardiographic, ETT + ICG profiles, and exercise performance were compared between patients with metabolic syndrome and the ones without. Sensitivity analyses were performed excluding patients without established coronary heart disease and further 1:1 paired for age and gender, respectively. Multiple linear regression was used to find out related predictors for maximal metabolic equivalents (METs).ResultsThree hundred and twenty-third patients were included, among whom 97 were diagnosed as metabolic syndrome. Compared to patients without metabolic syndrome, echocardiography showed that patients with metabolic syndrome had a significantly lower E/A ratio (p < 0.001). Besides, they have larger left atrium, larger right ventricle, and thicker interventricular septum (all p < 0.001), but similar left ventricular ejection fraction (P = 0.443). ICG showed that patients with metabolic syndrome had significantly higher stroke volume at rest and maximum (p < 0.001), higher left cardiac work index at rest and maximum (p = 0.005), higher systemic vascular resistance (SVR) at rest (p < 0.001), but similar SVI (p = 0.888). During exercise, patients with metabolic syndrome had lower maximal METs (p < 0.001), and a higher proportion suffering from ST-segment depression during exercise (p = 0.009). Sensitivity analyses yielded similar results. As for the linear regression model, 6 independent variables (systolic blood pressure, BMI, E/A ratio, the height of O wave, the peak value of LCWi, and the baseline of SVR) had statistically significant effects on the maximal METs tested in exercise (R = 0.525, R2 = 0.246, P < 0.001).ConclusionPatients with metabolic syndrome had significant structural alteration, apparent overburden of left ventricular work index, pre-and afterload, which may be the main cause of impaired exercise tolerance.
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Affiliation(s)
- Jiming Chen
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xing Wang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- National Health Committee (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Bin Dong
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- National Health Committee (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Chen Liu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- National Health Committee (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Jingjing Zhao
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- National Health Committee (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yugang Dong
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- National Health Committee (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Weihao Liang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- National Health Committee (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
- Weihao Liang
| | - Huiling Huang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- National Health Committee (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Huiling Huang
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Frundi DS, Kettig E, Popp LL, Hoffman M, Dumartin M, Hughes M, Lamy E, Fru YJW, Bano A, Muka T, Wilhelm M. Physical performance and glycemic control under SGLT-2-inhibitors in patients with type 2 diabetes and established atherosclerotic cardiovascular diseases or high cardiovascular risk (PUSH): Design of a 4-week prospective observational study. Front Cardiovasc Med 2022; 9:907385. [PMID: 35935634 PMCID: PMC9354468 DOI: 10.3389/fcvm.2022.907385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Type 2 diabetes (T2D) is associated with limitation in physical performance. Results from animal studies report enhancement of physical performance in T2D rodents treated with sodium glucose cotransporter 2 inhibitors (SGLT2is). However, in human patients with T2D and established atherosclerotic cardiovascular disease (ASCVD) or high cardiovascular risk, the impact of guideline directed SGLT2i medication on physical performance has not been sufficiently examined. Objectives The main objectives of this study are thus firstly, to assess the changes in physical performance after 4 weeks of exercise therapy in patients with established ASCVD or high cardiovascular risk categorized into three groups according to their glycemic control at baseline. Secondly, to investigate the association of glycemic control at baseline and new guideline directed antidiabetic treatment (inadequate glycemic control and diabetes + new SGLT2i vs. adequate glycemic control and diabetes vs. no diabetes) with change in physical performance. Methods and design This is a 4-week prospective observational study of 450 participants with established ASCVD or high cardiovascular risk with or without T2D and without previous SGLT2i medication undergoing exercise therapy during inpatient rehabilitation in a single center in Switzerland. Upon admission, participants are categorized into 3 groups of 150 participants each according to their glycemic control. Group I consisting of participants with inadequately controlled T2D defined as mean fasting plasma glucose (FPG) of ≥7 mmol/L, who are consequently administered new treatment with an SGLT2i. Group II comprises of participants with adequately controlled T2D with mean FPG of <7 mmol/L requiring no antidiabetic medication change. Group III consists of participants with no diabetes and mean FPG of ≤ 5.5 mmol/L. Primary outcomes are 6-min walk distance and rate of perceived exertion. Secondary outcomes are echocardiographic parameters (left ventricular mass index; global longitudinal strain average; end-diastolic volume), fatigue, muscle, metabolic, and anthropometric measures. Ethics and dissemination This study is conducted in accordance with the Declaration of Helsinki with ethical approval from the Cantonal Ethical Commission of Bern, Switzerland. The results will be published in a peer-reviewed journal. The implementation and reporting will be according to the SPIRIT guidelines. Study protocol registration https://www.clinicaltrials.gov/, identifier: NCT03422263.
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Affiliation(s)
- Devine S. Frundi
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
- Permanence Médicale, Hôpital de Sierre, Sierre, Switzerland
- *Correspondence: Devine S. Frundi
| | - Eva Kettig
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Lena Luise Popp
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Melanie Hoffman
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Marine Dumartin
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Magali Hughes
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | - Edgar Lamy
- Berner Klinik Montana, Zentrum für Medizinische und Neurologische Rehabilitation, Crans-Montana, Switzerland
| | | | - Arjola Bano
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Center for Preventive Cardiology, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Matthias Wilhelm
- Center for Preventive Cardiology, University Hospital Bern and University of Bern, Bern, Switzerland
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Lu YJ, Chen SY, Lai YC, Chaiyawat P, Chao YH, Chuang LM, Shih TTF, Wang HK. Muscle Microcirculatory Responses to Incremental Exercises Are Correlated with Peak Oxygen Uptake in Individuals With and Without Type 2 Diabetes Mellitus. Metab Syndr Relat Disord 2022; 20:405-413. [PMID: 35594301 DOI: 10.1089/met.2021.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Background: The role of impaired oxygen extraction on peak oxygen uptake (V̇O2peak) has been extensively studied using noninvasive and indirect methods in both diabetic patients and healthy participants. Methods: A total of 22 participants with type 2 diabetes mellitus [T2DM; median (range) age: 60 (47-70) years] and 22 controls [58 (52-69) years] with no history of diabetes were recruited (reference no. 201812135RINB). Subjects performed an exhaustive incremental exercise and were evaluated using a gas analyzer and near-infrared spectroscopy (NIRS) to determine V̇O2peak and changes in muscle oxygenation (SmO2) in the vastus lateralis, respectively. Measurements were taken at rest, warm-up, a period during exercise when SmO2 reached a minimum saturation plateau, and recovery. The microcirculatory responses of the vastus lateralis muscle during incremental exercise in patients with T2DM were compared with those in control individuals, and the correlation between changes in SmO2 and V̇O2peak was estimated. Results: The diabetic group demonstrated lower V̇O2peak, peak workload, peak heart rate, peak minute ventilation (all P < 0.05), and lower SmO2 during the rest, warm-up, and recovery phases (all P < 0.05) compared with the control group. A correlation was observed between the change in SmO2 between the warm-up and plateau value and the V̇O2peak (r = 0.608, P = 0.006). Conclusions: The results obtained in this study using NIRS support the feasibility of directly measuring changes in muscle SmO2 magnitudes to estimate the contributions of peripheral active muscle to systemic O2 uptake (V̇O2) during incremental exercise.
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Affiliation(s)
- Yan-Jhen Lu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Ssu-Yuan Chen
- Division of Physical Medicine and Rehabilitation, Fu Jen Catholic University Hospital, New Taipei City, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Chuen Lai
- Division of Metabolism and Endocrinology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | - Yuan-Hung Chao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Lee-Ming Chuang
- Division of Metabolism and Endocrinology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tiffany Ting-Fang Shih
- Department of Medical Image and Radiology, Medical College and Hospital, National Taiwan University, Taipei, Taiwan
| | - Hsing-Kuo Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
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11
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MacDonald TL, Pattamaprapanont P, Cooney EM, Nava RC, Mitri J, Hafida S, Lessard SJ. Canagliflozin Prevents Hyperglycemia-Associated Muscle Extracellular Matrix Accumulation and Improves the Adaptive Response to Aerobic Exercise. Diabetes 2022; 71:881-893. [PMID: 35108373 PMCID: PMC9044131 DOI: 10.2337/db21-0934] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/27/2022] [Indexed: 02/03/2023]
Abstract
Chronic hyperglycemia is associated with low response to aerobic exercise training in rodent models and humans, including reduced aerobic exercise capacity and impaired oxidative remodeling in skeletal muscle. Here, we investigated whether glucose lowering with the sodium-glucose cotransporter 2 inhibitor (SGLT2i), canagliflozin (Cana; 30 mg/kg/day), could restore exercise training response in a model of hyperglycemia (low-dose streptozotocin [STZ]). Cana effectively prevented increased blood glucose in STZ-treated mice. After 6 weeks of voluntary wheel running, Cana-treated mice displayed improvements in aerobic exercise capacity, higher capillary density in striated muscle, and a more oxidative fiber-type in skeletal muscle. In contrast, these responses were blunted or absent in STZ-treated mice. Recent work implicates glucose-induced accumulation of skeletal muscle extracellular matrix (ECM) and hyperactivation of c-Jun N-terminal kinase (JNK)/SMAD2 mechanical signaling as potential mechanisms underlying poor exercise response. In line with this, muscle ECM accretion was prevented by Cana in STZ-treated mice. JNK/SMAD2 signaling with acute exercise was twofold higher in STZ compared with control but was normalized by Cana. In human participants, ECM accumulation was associated with increased JNK signaling, low VO2peak, and impaired metabolic health (oral glucose tolerance test-derived insulin sensitivity). These data demonstrate that hyperglycemia-associated impairments in exercise adaptation can be ameliorated by cotherapy with SGLT2i.
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Affiliation(s)
- Tara L. MacDonald
- Research Division, Joslin Diabetes Center, Boston, MA
- Harvard Medical School, Boston, MA
| | | | | | - Roberto C. Nava
- Research Division, Joslin Diabetes Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Joanna Mitri
- Research Division, Joslin Diabetes Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Samar Hafida
- Research Division, Joslin Diabetes Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Sarah J. Lessard
- Research Division, Joslin Diabetes Center, Boston, MA
- Harvard Medical School, Boston, MA
- Corresponding author: Sarah J. Lessard,
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12
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Greenman AC, Diffee GM, Power AS, Wilkins GT, Gold OMS, Erickson JR, Baldi JC. Treadmill running increases the calcium sensitivity of myofilaments in diabetic rats. J Appl Physiol (1985) 2022; 132:1350-1360. [PMID: 35482324 DOI: 10.1152/japplphysiol.00785.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The cardiovascular benefits of regular exercise are unequivocal, yet patients with type 2 diabetes respond poorly to exercise due to a reduced cardiac reserve. The contractile response of diabetic cardiomyocytes to beta-adrenergic stimulation is attenuated, which may result in altered myofilament calcium sensitivity and post-translational modifications of cardiac troponin I (cTnI). Treadmill running increases myofilament calcium sensitivity in non‑diabetic rats, and thus we hypothesized that endurance training would increase calcium sensitivity of diabetic cardiomyocytes and alter site-specific phosphorylation of cTnI. Calcium sensitivity, or pCa50, was measured in Zucker Diabetic Fatty (ZDF) non-diabetic (nDM) and diabetic (DM) rat hearts after 8 weeks of either a sedentary (SED) or progressive treadmill running (TR) intervention. Skinned cardiomyocytes were connected to a capacitance-gauge transducer and a torque motor to measure force as a function of pCa (‑log[Ca2+]). Specific phospho-sites on cTnI and O‑GlcNAcylation were quantified by immunoblot and total protein phosphorylation by fluorescent gel staining (ProQ Diamond). The novel finding in this study was that training increased pCa50 in both DM and nDM cardiomyocytes (p = 0.009). Phosphorylation of cTnI amino acid residues Ser23/24, a crucial protein kinase A site, and Threonine (Thr)144, was lower in DM hearts, but there was no effect of training on site-specific phosphorylation. Additionally, total phosphorylation and O-GlcNAcylation levels were not different between SED and TR groups. These findings suggest that regular exercise may benefit the diabetic heart by specifically targeting myofilament contractile function.
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Affiliation(s)
- Angela Claire Greenman
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand.,Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand.,HeartOtago, University of Otago, Dunedin, New Zealand
| | - Gary M Diffee
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI
| | - Amelia S Power
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand.,HeartOtago, University of Otago, Dunedin, New Zealand
| | - Gerard T Wilkins
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand.,HeartOtago, University of Otago, Dunedin, New Zealand
| | - Olivia M S Gold
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand.,HeartOtago, University of Otago, Dunedin, New Zealand
| | - Jeffrey R Erickson
- Department of Physiology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand.,HeartOtago, University of Otago, Dunedin, New Zealand
| | - James C Baldi
- Department of Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand.,HeartOtago, University of Otago, Dunedin, New Zealand
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13
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Poole DC. Can exercise training help redress sexual dimorphism in type II diabetes outcomes? J Diabetes Complications 2022; 36:108099. [PMID: 34916148 DOI: 10.1016/j.jdiacomp.2021.108099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Affiliation(s)
- David C Poole
- Department of Kinesiology and Department of Anatomy and Physiology, Kansas State University, Manhattan, KS 66506, USA.
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14
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Kaze AD, Agoons DD, Santhanam P, Erqou S, Ahima RS, Echouffo-Tcheugui JB. Correlates of cardiorespiratory fitness among overweight or obese individuals with type 2 diabetes. BMJ Open Diabetes Res Care 2022; 10:10/1/e002446. [PMID: 34987052 PMCID: PMC8734012 DOI: 10.1136/bmjdrc-2021-002446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/17/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Mechanistic studies suggest that type 2 diabetes is independently associated with low cardiorespiratory fitness (CRF). Little is known about the CRF profile in type 2 diabetes; we assessed the correlates of low CRF among overweight/obese adults with type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 4215 participants with type 2 diabetes and without cardiovascular disease underwent maximal exercise testing in the Look AHEAD (Action for Health in Diabetes) study. Low CRF was defined based on the Aerobics Center Longitudinal Study reference standards. Calorie intake and physical activity were assessed using questionnaires. Body fat composition was assessed using dual-energy X-ray absorptiometry. RESULTS Waist circumference, systolic blood pressure, glycemic measures, whole body fat, caloric intake, and fat-free mass were inversely associated with fitness across sex (all p<0.001). Comparing with moderate or high CRF groups, the low CRF group was associated with higher adjusted odds of obesity (OR 3.19 (95% CI 1.95 to 5.20) in men, 3.86 (95% CI 2.55 to 5.84)) in women), abdominal obesity (OR 3.99 (95% CI 2.00 to 7.96) in men, 2.28 (95% CI 1.08 to 4.79) in women), hypertension (OR 1.74 (95% CI 1.09 to 2.77) in men, 1.44 (95% CI 1.02 to 2.05) in women), metabolic syndrome (OR 5.52 (95% CI 2.51 to 12.14) in men, 2.25 (95% CI 1.35 to 3.76) in women), use of beta-blocker (1.22 (95% CI 0.86 to 1.73) in men, 1.33 (95% CI 1.03 to 1.73) in women), and ACE inhibitor/angiotensin-receptor blocker (1.86 (95% CI 1.39 to 2.50) in men, 1.07 (95% CI 0.86 to 1.32) in women). Women with low CRF had higher odds of current smoking (2.02 (95% CI 1.25 to 3.28)). CONCLUSIONS Low CRF was associated with increased odds of cardiometabolic correlates in a large cohort of adults with type 2 diabetes.
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Affiliation(s)
- Arnaud D Kaze
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Dayawa Da Agoons
- Department of Medicine, UPMC Pinnacle, Harrisburg, Pennsylvania, USA
| | - Prasanna Santhanam
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sebhat Erqou
- Department of Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Rexford S Ahima
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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15
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The Application of Exercise Training for Diabetic Peripheral Neuropathy. J Clin Med 2021; 10:jcm10215042. [PMID: 34768562 PMCID: PMC8584831 DOI: 10.3390/jcm10215042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 12/15/2022] Open
Abstract
Diabetic peripheral neuropathy (DPN) is the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after the exclusion of other causes. It is associated with pain, paresthesia, sensory loss, muscle atrophy with fat infiltration, and muscular dysfunction typically starting distally in the feet and progressing proximally. Muscle deterioration within the leg and foot can lead to muscle dysfunction, reduced mobility, and increases the risk of disability, ulceration, and amputation. Exercise training is an established method for increasing the different components of physical fitness, including enhancing body composition and improving neuromuscular strength. A number of experimental studies have utilized exercise training to treat various impairments associated with DPN, such as nerve conduction velocity, pain tolerance, and balance. However, the broad spectrum of exercise training modalities implemented and differences in target outcome measurements have made it difficult to understand the efficacy of exercise training interventions or provide appropriate exercise prescription recommendations. Therefore, the aims of this review were to (1) briefly describe the pathophysiology of DPN and (2) discuss the effects of exercise training interventions on sensorimotor, metabolic, and physical functions in people with DPN.
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16
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Leung V, Wroblewski K, Schumm LP, Huisingh-Scheetz M, Huang ES. Reexamining the Classification of Older Adults With Diabetes by Comorbidities and Exploring Relationships With Frailty, Disability, and 5-year Mortality. J Gerontol A Biol Sci Med Sci 2021; 76:2071-2079. [PMID: 34003280 PMCID: PMC8514058 DOI: 10.1093/gerona/glab141] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Limited research has been conducted to risk stratify older adults with diabetes. Our objective was to reexamine the 2005-2006 classification systems in participants who are now 5 years older. METHODS We examined a subsample of 884 community-residing older adults with the diagnosis of diabetes from the National Social Life, Health, and Aging Project. The primary objective was to utilize a latent class analysis (LCA) to fit a model to 11 comorbidities, comparing the 2010-2011 LCA model to that of 2005-2006. The secondary objective was to evaluate the association of the identified classes with frailty, disability, and 5-year mortality. RESULTS Both 2005-2006 LCA and the 2010-2011 LCA model fit 3 similar comorbidity profiles: Class 1 with the lowest rates of nearly all comorbidities, Class 2 had highest rates of obesity, hypertension, arthritis, and incontinence, and Class 3 had the higher rates of myocardial infarctions, congestive heart failure, and stroke. When compared to the healthier Class 1 (class probability = 0.67), participants with a comorbidity profile with more prevalent cardiovascular conditions (Class 3; 0.09) were at higher risk of frailty and mortality, but not disability; whereas participants with a comorbidity profile with more prevalent geriatric syndrome conditions (Class 2; 0.24) were at higher risk of frailty and disability, but not mortality. CONCLUSIONS We reconfirmed 3 latent classes with distinct comorbidity profiles among older adults with diabetes. However, the complex relationships between comorbidity classes with frailty, disability, and mortality will likely require revision of the current rationale for stratified goal setting and treatment selection.
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Affiliation(s)
- Vania Leung
- Department of Academic Internal Medicine and Geriatrics, University of Illinois at Chicago, USA
| | - Kristen Wroblewski
- Department of Public Health Sciences, University of Chicago, Illinois, USA
| | - L Philip Schumm
- Department of Public Health Sciences, University of Chicago, Illinois, USA
| | | | - Elbert S Huang
- Section of General Internal Medicine, University of Chicago, Illinois, USA
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17
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Khoo J, Hagemeyer CE, Henstridge DC, Kumble S, Wang TY, Xu R, Gani L, King T, Soh SB, Puar T, Au V, Tan E, Tay TL, Kam C, Teo EK. Effects of water stably-enriched with oxygen as a novel method of tissue oxygenation on mitochondrial function, and as adjuvant therapy for type 2 diabetes in a randomized placebo-controlled trial. PLoS One 2021; 16:e0254619. [PMID: 34260650 PMCID: PMC8279347 DOI: 10.1371/journal.pone.0254619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 06/07/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Diabetes mellitus is associated with inadequate delivery of oxygen to tissues. Cellular hypoxia is associated with mitochondrial dysfunction which increases oxidative stress and hyperglycaemia. Hyperbaric oxygenation therapy, which was shown to improve insulin sensitivity, is impractical for regular use. We evaluated the effects of water which is stably-enriched with oxygen (ELO water) to increase arterial blood oxygen levels, on mitochondrial function in the presence of normal- or high-glucose environments, and as glucose-lowering therapy in humans. METHODS We compared arterial blood oxygen levels in Sprague-Dawley rats after 7 days of ad libitum ELO or tap water consumption. Mitochondrial stress testing, and flow cytometry analysis of mitochondrial mass and membrane potential, were performed on human HepG2 cells cultured in four Dulbecco's Modified Eagle Medium media, made with ELO water or regular (control) water, at normal (5.5 mM) or high (25 mM) glucose concentrations. We also randomized 150 adults with type 2 diabetes (mean age 53 years, glycated haemoglobin HbA1c 8.9% [74 mmol/mol], average duration of diabetes 12 years) to drink 1.5 litres daily of bottled ELO water or drinking water. RESULTS ELO water raised arterial oxygen tension pO2 significantly (335 ± 26 vs. 188 ± 18 mmHg, p = 0.006) compared with tap water. In cells cultured in control water, mitochondrial mass and membrane potential were both significantly lower at 25 mM glucose compared with 5.5 mM glucose; in contrast, mitochondrial mass and membrane potential did not differ significantly at normal or high glucose concentrations in cells cultured in ELO water. The high-glucose environment induced a greater mitochondrial proton leak in cells cultured in ELO water compared to cells cultured in control medium at similar glucose concentration. In type 2 diabetic adults, HbA1c decreased significantly (p = 0.002) by 0.3 ± 0.7% (4 ± 8 mmol/mol), with ELO water after 12 weeks of treatment but was unchanged with placebo. CONCLUSIONS ELO water raises arterial blood oxygen levels, appears to have a protective effect on hyperglycaemia-induced reduction in mitochondrial mass and mitochondrial dysfunction, and may be effective adjuvant therapy for type 2 diabetes.
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Affiliation(s)
- Joan Khoo
- Department of Medicine, Changi General Hospital, Singapore, Singapore
| | | | - Darren C. Henstridge
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Sumukh Kumble
- NanoBiotechnology Laboratory, Monash University, Melbourne, Victoria, Australia
| | - Ting-Yi Wang
- NanoBiotechnology Laboratory, Monash University, Melbourne, Victoria, Australia
| | - Rong Xu
- NanoBiotechnology Laboratory, Monash University, Melbourne, Victoria, Australia
| | - Linsey Gani
- Department of Medicine, Changi General Hospital, Singapore, Singapore
| | - Thomas King
- Department of Medicine, Changi General Hospital, Singapore, Singapore
| | - Shui-Boon Soh
- Department of Medicine, Changi General Hospital, Singapore, Singapore
| | - Troy Puar
- Department of Medicine, Changi General Hospital, Singapore, Singapore
| | - Vanessa Au
- Department of Medicine, Changi General Hospital, Singapore, Singapore
| | - Eberta Tan
- Department of Medicine, Changi General Hospital, Singapore, Singapore
| | - Tunn-Lin Tay
- Department of Medicine, Changi General Hospital, Singapore, Singapore
| | - Carmen Kam
- Clinical Trials and Research Unit, Changi General Hospital, Singapore, Singapore
| | - Eng-Kiong Teo
- Department of Medicine, Changi General Hospital, Singapore, Singapore
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18
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Sabouri M, Hatami E, Pournemati P, Shabkhiz F. Inflammatory, antioxidant and glycemic status to different mode of high-intensity training in type 2 diabetes mellitus. Mol Biol Rep 2021; 48:5291-5304. [PMID: 34228273 DOI: 10.1007/s11033-021-06539-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/27/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Exercise has traditionally been used and prescribed as an effective and suitable way to treat type 2 diabetics Mellitus (T2DM). In this regard, we compared inflammatory, antioxidant, and glycemic status to different kinds of high-intensity interval training (strength training, HIIT, and HIIT + ST) in patients with T2DM. METHODS AND RESULTS Fifty-nine T2DM patients (age = 45-60 yrs) were randomly divided to strength training (ST) (n = 15), high intensity interval training (HIIT) (n = 16), HIIT + ST (n = 15) or served as control (CON) (n = 13) groups. Experimental groups performed three training sessions/week for 12 weeks. Inflammatory, antioxidant, glycemic factors, and anthropometric parameters were evaluated at baseline and after the 12 weeks of interventions. Training HIIT groups significantly improved antioxidant factors, lipid profile, and glycemic parameters (P ≤ 0.05). Interleukin 6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α) significantly decreased in the three training groups. As a result of training, the overall inflammatory and antioxidant status were improved considerably in all three training groups compared to the CON group (P ≤ 0.05). In addition, there were significant differences in CRP at the follow-up values between ST and CON groups (P ≤ 0.05). Exercise time and TC were significantly improved in HIIT than in the CON group (P ≤ 0.05). The results showed a significant difference between the HIIT + ST group and the CON group in VO2peak (P ≤ 0.05). CONCLUSIONS Our results showed improvement in inflammatory factors, antioxidants, and glycemic parameters in all training groups regardless of their type. However, for more benefits in T2DM patients, combination exercises can be suggested.
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Affiliation(s)
- Mostafa Sabouri
- Department of Exercise Physiology & Health Science, University of Tehran, Tehran, Iran.
| | - Elaheh Hatami
- Department of Exercise Physiology, Sport Sciences Research Institute, Tehran, Iran
| | - Parisa Pournemati
- Department of Exercise Physiology & Health Science, University of Tehran, Tehran, Iran
| | - Fatemeh Shabkhiz
- Department of Exercise Physiology & Health Science, University of Tehran, Tehran, Iran.
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19
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Community-Based Exercise and Lifestyle Program Improves Health Outcomes in Older Adults with Type 2 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116147. [PMID: 34200198 PMCID: PMC8200982 DOI: 10.3390/ijerph18116147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The aim of this study was to assess the efficacy of Beat It-a community-based exercise and lifestyle intervention-in improving anthropometric and physical fitness outcomes in older adults with type 2 diabetes mellitus (T2DM). METHODS Australians with T2DM who were aged 60 years or older were included. These individuals were enrolled in Beat It, a twice-weekly supervised group exercise and education program conducted over 8 weeks. Anthropometric measurements and physical fitness parameters were assessed at baseline and completion. Physical fitness measures were then compared to validated criterion standards of fitness levels required by older adults to remain physically independent into later life. RESULTS A total of 588 individuals were included in the study. At baseline, a substantial proportion of the cohort had physical fitness measures that were below the standard for healthy independent living for their gender and age. Significant improvements in waist circumference and physical fitness were observed post program and resulted in an increase in the number of participants who met the standard for healthy independent living. CONCLUSIONS Participation in Beat It improved important health outcomes in older adults with T2DM. A longer-term follow-up is needed to determine whether these positive changes were maintained beyond the delivery of the program.
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20
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Mickute M, Henson J, Rowlands AV, Sargeant JA, Webb D, Hall AP, Edwardson CL, Baldry EL, Brady EM, Khunti K, Davies MJ, Yates T. Device-measured physical activity and its association with physical function in adults with type 2 diabetes mellitus. Diabet Med 2021; 38:e14393. [PMID: 32844472 DOI: 10.1111/dme.14393] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/30/2020] [Accepted: 08/18/2020] [Indexed: 12/14/2022]
Abstract
AIM To quantify how differences in metrics characterizing physical activity and sedentary behaviour in type 2 diabetes are associated with physical function. METHODS This analysis included participants' data from the Chronotype of Patients with Type 2 Diabetes and Effect on Glycaemic Control (CODEC) cross-sectional study. Data were stratified into two groups according to their short physical performance battery (SPPB) score (impaired physical function = SPPB < 10 and normal physical function = SPPB ≥ 10). Hand-grip strength, sit-to-stand 60 (STS-60) and the Duke Activity Status Index (DASI) score were used to assess functional capacity, while physical activity metrics were measured with a wrist-worn accelerometer. The associations between physical activity metrics and measures of functional capacity were analysed using generalized linear modelling. RESULTS Some 635 adults (median age 66 years, 34% female) were included in this analysis. Overall, 29% of the cohort scored < 10 in the SPPB test indicating impaired physical function. This group spent more time in prolonged sedentary behaviour (600.7 vs. 572.5 min) and undertook less-intense physical activity. Each sd increase in physical activity volume and intensity gradients for those with impaired physical function was associated with 17% more repetitions for STS-60 with similar associations seen for DASI score. Each sd in sedentary time was associated with 15% fewer repetitions in STS-60 and 16% lower DASI score in those with impaired physical function, whereas in normal physical function group it was 2% and 1%, respectively. CONCLUSIONS The strength of the associations for physical activity measures and functional capacity were modified by physical function status, with the strongest association seen in those with impaired physical function.
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Affiliation(s)
- M Mickute
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - J Henson
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - A V Rowlands
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - J A Sargeant
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - D Webb
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - A P Hall
- The Hanning Sleep Laboratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - C L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - E L Baldry
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - E M Brady
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Institute for Health Research (NIHR) Applied Research Collaboration East Midlands, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - M J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - T Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
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Kaze AD, Santhanam P, Erqou S, Bertoni AG, Ahima RS, Echouffo-Tcheugui JB. Cardiorespiratory Fitness and Atherosclerotic Cardiovascular Outcomes by Levels of Baseline-Predicted Cardiovascular Risk: The Look AHEAD Study. Am J Med 2021; 134:769-776.e1. [PMID: 33607087 PMCID: PMC8176653 DOI: 10.1016/j.amjmed.2021.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND We evaluated the associations of cardiorespiratory fitness with atherosclerotic cardiovascular disease (ASCVD) by levels of baseline-predicted ASCVD risk among adults with type 2 diabetes. METHODS We analyzed data from 4203 adults with type 2 diabetes in the Look AHEAD (Action for Health in Diabetes) study. Cardiorespiratory fitness was assessed using maximal exercise testing and categorized into low, moderate, and high; baseline-predicted. ASCVD risk was calculated using the American College of Cardiology/American Heart Association Pooled Cohort Equation. We used Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for ASCVD events (fatal and nonfatal myocardial infarction and stroke). RESULTS Over a median of 9.6 years, there were 295 ASCVD events. The effect of fitness on outcomes was different across levels of 10-year predicted ASCVD risk (P for interaction < .001). Among participants with a baseline-predicted risk of 7.5% to 20%, the HR of low (vs high) fitness group was 1.94 (95% CI, 1.12-3.35) for ASCVD events. Fitness was not significantly associated with ASCVD events in the groups with baseline-predicted risk <7.5% (HR 1.53; 95% CI, 0.49-4.76) or ≥20% (HR 1.40; 95% CI, 0.88-2.24). A similar pattern was observed for myocardial infarction and stroke separately. CONCLUSIONS In a large sample of type 2 diabetes individuals, the association of low fitness with incident ASCVD was modified by the baseline-predicted 10-year ASCVD risk. Our findings suggest the utility of assessing fitness in ASCVD risk stratification in type 2 diabetes, especially among those with intermediate predicted 10-year risk of ASCVD.
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Affiliation(s)
- Arnaud D Kaze
- Department of Medicine, University of Maryland Medical Center, Baltimore
| | - Prasanna Santhanam
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, Md
| | - Sebhat Erqou
- Department of Medicine, Providence VA Medical Center and Alpert Medical School of Brown University, Providence, RI
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Rexford S Ahima
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, Md
| | - Justin B Echouffo-Tcheugui
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, Md.
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22
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Lai YC, Chao YH, Kuo CY, Lee WN, Chuang L, Shih TTF, Rolf C, Wang HK. Microcirculatory Responses to Muscle and Tendon Exercises in Individuals With and Without Type 2 Diabetes Mellitus and the Association Between Microcirculatory and Exercise Performance. Metab Syndr Relat Disord 2021; 19:325-331. [PMID: 34030471 DOI: 10.1089/met.2020.0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed to measure and compare (1) the microcirculation and microcirculatory responses of the muscles and tendons at rest and during isometric muscle contractions in participants with and without diabetes mellitus (DM) and (2) to determine correlations between microcirculation and muscle strength. Methods: Sixty-three participants with type 2 DM and 42 physically matched controls were recruited. Baseline measurements of the microcirculation of the rectus femoris (RF) and medial gastrocnemius (MG) muscles and patellar (PT) and Achilles tendons (AT), as well as their microcirculatory changes during maximal isometric exercises, were performed and recorded by using near-infrared spectroscopy and a red laser. Data on various laboratory tests (including glycated hemoglobin, triglyceride, high-density cholesterol), the monofilament test, and the ankle-brachial index were also obtained. Results: The baseline measurements indicated that, compared with the controls, the diabetic participants had lower oxygen saturation (SpO2) in their RF and MG muscles (both P < 0.001), and the total hemoglobin in the diabetic PT and AT was higher (P = 0.001 and P = 0.01). The minimal SpO2 levels in the aforementioned muscles during isometric contractions were lower in the diabetes group than in the control group (P ≤ 0.001). Furthermore, there were correlations between the microcirculatory change of the RF muscle and the knee extension force. Conclusions: This study demonstrated the effects of diabetes on the microcirculation of skeletal muscles and tendons during baseline measurements and responses to maximal isometric exercises. The results support the need for preventive strategies for diabetic muscles to prevent adverse complications when performing resistance training.
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Affiliation(s)
- Ying-Chuen Lai
- Division of Metabolism and Endocrinology, Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yuan-Hung Chao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Yu Kuo
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Ning Lee
- Department of Electrical and Electronic Engineering, and Medical Engineering Programme, The University of Hong Kong, Hong Kong, China
| | - Leeming Chuang
- Division of Metabolism and Endocrinology, Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tiffany T F Shih
- Department of Medical Image and Radiology, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - Christer Rolf
- Department of Orthopaedics, Clintec, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Hsing-Kuo Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
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23
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Grotle AK, Kaur J, Stone AJ, Fadel PJ. Neurovascular Dysregulation During Exercise in Type 2 Diabetes. Front Physiol 2021; 12:628840. [PMID: 33927637 PMCID: PMC8076798 DOI: 10.3389/fphys.2021.628840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/05/2021] [Indexed: 12/12/2022] Open
Abstract
Emerging evidence suggests that type 2 diabetes (T2D) may impair the ability to properly adjust the circulation during exercise with augmented blood pressure (BP) and an attenuated contracting skeletal muscle blood flow (BF) response being reported. This review provides a brief overview of the current understanding of these altered exercise responses in T2D and the potential underlying mechanisms, with an emphasis on the sympathetic nervous system and its regulation during exercise. The research presented support augmented sympathetic activation, heightened BP, reduced skeletal muscle BF, and impairment in the ability to attenuate sympathetically mediated vasoconstriction (i.e., functional sympatholysis) as potential drivers of neurovascular dysregulation during exercise in T2D. Furthermore, emerging evidence supporting a contribution of the exercise pressor reflex and central command is discussed along with proposed future directions for studies in this important area of research.
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Affiliation(s)
- Ann-Katrin Grotle
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX, United States
| | - Jasdeep Kaur
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Audrey J Stone
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Paul J Fadel
- Department of Kinesiology, The University of Texas at Arlington, Arlington, TX, United States
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24
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Adenwalla SF, Billany RE, March DS, Gulsin GS, Young HML, Highton P, Churchward DC, Young R, Careless A, Tomlinson CL, McCann GP, Burton JO, Graham-Brown MPM. The cardiovascular determinants of physical function in patients with end-stage kidney disease on haemodialysis. Int J Cardiovasc Imaging 2021; 37:1405-1414. [PMID: 33258084 PMCID: PMC8026413 DOI: 10.1007/s10554-020-02112-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/20/2020] [Indexed: 12/11/2022]
Abstract
Patients with end-stage kidney disease (ESKD) are often sedentary and decreased functional capacity associates with mortality. The relationship between cardiovascular disease (CVD) and physical function has not been fully explored. Understanding the relationships between prognostically relevant measures of CVD and physical function may offer insight into how exercise interventions might target specific elements of CVD. 130 patients on haemodialysis (mean age 57 ± 15 years, 73% male, dialysis vintage 1.3 years (0.5, 3.4), recruited to the CYCLE-HD trial (ISRCTN11299707), underwent cardiovascular phenotyping with cardiac MRI (left ventricular (LV) structure and function, pulse wave velocity (PWV) and native T1 mapping) and cardiac biomarker assessment. Participants completed the incremental shuttle walk test (ISWT) and sit-to-stand 60 (STS60) as field-tests of physical function. Linear regression models identified CV determinants of physical function measures, adjusted for age, gender, BMI, diabetes, ethnicity and systolic blood pressure. Troponin I, PWV and global native T1 were univariate determinants of ISWT and STS60 performance. NT pro-BNP was a univariate determinant of ISWT performance. In multivariate models, NT pro-BNP and global native T1 were independent determinants of ISWT and STS60 performance. LV ejection fraction was an independent determinant of ISWT distance. However, age and diabetes had the strongest relationships with physical function. In conclusion, NT pro-BNP, global native T1 and LV ejection fraction were independent CV determinants of physical function. However, age and diabetes had the greatest independent influence. Targeting diabetic care may ameliorate deconditioning in these patients and a multimorbidity approach should be considered when developing exercise interventions.
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Affiliation(s)
- Sherna F. Adenwalla
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Roseanne E. Billany
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Daniel S. March
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Gaurav S. Gulsin
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Hannah M. L. Young
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Research and Innovation Department, University Hospitals Leicester NHS Trust, Leicester, UK
| | - Patrick Highton
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Darren C. Churchward
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Robin Young
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Alysha Careless
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Clare L. Tomlinson
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - James O. Burton
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Matthew P. M. Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
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25
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Metabolomics reveals the impact of Type 2 diabetes on local muscle and vascular responses to ischemic stress. Clin Sci (Lond) 2021; 134:2369-2379. [PMID: 32880388 DOI: 10.1042/cs20191227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 08/24/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Type 2 diabetes mellitus (T2DM) reduces exercise capacity, but the mechanisms are incompletely understood. We probed the impact of ischemic stress on skeletal muscle metabolite signatures and T2DM-related vascular dysfunction. METHODS we recruited 38 subjects (18 healthy, 20 T2DM), placed an antecubital intravenous catheter, and performed ipsilateral brachial artery reactivity testing. Blood samples for plasma metabolite profiling were obtained at baseline and immediately upon cuff release after 5 min of ischemia. Brachial artery diameter was measured at baseline and 1 min after cuff release. RESULTS as expected, flow-mediated vasodilation was attenuated in subjects with T2DM (P<0.01). We confirmed known T2DM-associated baseline differences in plasma metabolites, including homocysteine, dimethylguanidino valeric acid and β-alanine (all P<0.05). Ischemia-induced metabolite changes that differed between groups included 5-hydroxyindoleacetic acid (healthy: -27%; DM +14%), orotic acid (healthy: +5%; DM -7%), trimethylamine-N-oxide (healthy: -51%; DM +0.2%), and glyoxylic acid (healthy: +19%; DM -6%) (all P<0.05). Levels of serine, betaine, β-aminoisobutyric acid and anthranilic acid were associated with vessel diameter at baseline, but only in T2DM (all P<0.05). Metabolite responses to ischemia were significantly associated with vasodilation extent, but primarily observed in T2DM, and included enrichment in phospholipid metabolism (P<0.05). CONCLUSIONS our study highlights impairments in muscle and vascular signaling at rest and during ischemic stress in T2DM. While metabolites change in both healthy and T2DM subjects in response to ischemia, the relationship between muscle metabolism and vascular function is modified in T2DM, suggesting that dysregulated muscle metabolism in T2DM may have direct effects on vascular function.
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26
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Foudi N, Legeay S. Effects of physical activity on cell-to-cell communication during type 2 diabetes: A focus on miRNA signaling. Fundam Clin Pharmacol 2021; 35:808-821. [PMID: 33675090 DOI: 10.1111/fcp.12665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 02/13/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022]
Abstract
Type 2 diabetes (TD2) is a progressive disease characterized by hyperglycemia that results from alteration in insulin secretion, insulin resistance, or both. A number of alterations involving different tissues and organs have been reported to the development and the progression of T2D, and more relevantly, through cell-to-cell communication pathways. Recent studies demonstrated that miRNAs are considerably implicated to cell-to-cell communication during T2D. Physical activity (PA) is associated with decreasing risks of developing T2D and acts as insulin-like factor. Cumulative evidence suggests that this effect could be mediated in part through improving insulin sensitivity in T2D and obese patients and modulating miRNAs synthesis and release in healthy patients. Therefore, the practice of PA should ideally be established before the initiation of T2D. This review describes cell-to-cell communications involved in the pathophysiology of T2D during PA.
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Affiliation(s)
- Nabil Foudi
- Department of Pharmacy, UNIV Angers, Angers, France.,Faculty of Medicine, Department of Pharmacy, University Ferhat Abbas Setif 1, Setif, Algeria
| | - Samuel Legeay
- MINT, UNIV Angers, INSERM 1066, CNRS 6021, IRIS-IBS-CHU, Angers, France
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27
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Bilak JM, Gulsin GS, McCann GP. Cardiovascular and systemic determinants of exercise capacity in people with type 2 diabetes mellitus. Ther Adv Endocrinol Metab 2021; 12:2042018820980235. [PMID: 33552463 PMCID: PMC7844448 DOI: 10.1177/2042018820980235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/20/2020] [Indexed: 12/15/2022] Open
Abstract
The global burden of heart failure (HF) is on the rise owing to an increasing incidence of lifestyle related diseases, predominantly type 2 diabetes mellitus (T2D). Diabetes is an independent risk factor for cardiovascular disease, and up to 75% of those with T2D develop HF in their lifetime. T2D leads to pathological alterations within the cardiovascular system, which can progress insidiously and asymptomatically in the absence of conventional risk factors. Reduced exercise tolerance is consistently reported, even in otherwise asymptomatic individuals with T2D, and is the first sign of a failing heart. Because aggressive modification of cardiovascular risk factors does not eliminate the risk of HF in T2D, it is likely that other factors play a role in the pathogenesis of HF. Early identification of individuals at risk of HF is advantageous, as it allows for modification of the reversible risk factors and early initiation of treatment with the aim of improving clinical outcomes. In this review, cardiac and extra-cardiac contributors to reduced exercise tolerance in people with T2D are explored.
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Affiliation(s)
- Joanna M. Bilak
- Department of Cardiovascular Sciences, University of Leicester and The National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Gaurav S. Gulsin
- Department of Cardiovascular Sciences, University of Leicester and The National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE39QP, UK
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28
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Baasch-Skytte T, Gunnarsson TP, Fiorenza M, Bangsbo J. Skeletal muscle proteins important for work capacity are altered with type 2 diabetes - Effect of 10-20-30 training. Physiol Rep 2021; 9:e14681. [PMID: 33426802 PMCID: PMC7797308 DOI: 10.14814/phy2.14681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 11/24/2022] Open
Abstract
The study examined whether men with type 2 diabetes exhibit lower expression of muscle proteins important for exercise capacity, and whether exercise training promotes adaptations in these proteins. In a cross-sectional and longitudinal study, conducted at the University of Copenhagen. Twelve men with type 2 diabetes (T2D) were compared to eleven nondiabetes counterparts (ND) matched for age and body composition (body fat percentage). T2D underwent 10 weeks of high-intensity interval exercise training (10-20-30 training). T2D had lower expression of SOD1 (-62%; p < 0.001) and ETC complex V (-34%; p = 0.003), along with higher expression of ETC complex IV (+66%; p = 0.007), MFN2 (+62%; p = 0.001), and DRP1 (+30%; p = 0.028) compared to ND. T2D had higher (p < 0.001) expression of Na+ /K+ α1 (+98%), α2 (+114%), and NHE1 (+144%) than ND. In T2D, training increased exercise capacity (+9%; p < 0.001) as well as expression of SOD2 (+44%; p = 0.029), ETC complex II (+25%; p = 0.035), III (+52%; p = 0.041), IV (+23%; p = 0.005), and V (+21%; p = 0.035), CS activity (+32%; p = 0.006) as well as Na+ /K+ α1 (+24%; p = 0.034), Kir6.2 (+36%; p = 0.029), and MCT1 (+20%; p = 0.007). Men with type 2 diabetes exhibited altered expression of a multitude of skeletal muscle proteins important for exercise capacity. Ten weeks of 10-20-30 training upregulated expression of muscle proteins regulating antioxidant defense, mitochondrial function, and ion handling while enhancing exercise capacity in men with type 2 diabetes.
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Affiliation(s)
- Thomas Baasch-Skytte
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Thomas P Gunnarsson
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Matteo Fiorenza
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jens Bangsbo
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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29
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Silva Filho PJD, Teodoro ECM, Pereira ECA, Miranda VCDR. Prevalence of peripheral arterial disease and associated factors in people with type 2 diabetes. FISIOTERAPIA EM MOVIMENTO 2021. [DOI: 10.1590/fm.2021.34122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract Introduction: The high rate of diabetes mellitus index (DM), along with the increase in cardiovascular compromise that DM favors, and the scarcity of epidemiological data regarding the prevalence of peripheral arterial disease (PAD) in this population, make it important to study risk factors associated with the development of PAD in the population with type 2 diabetes mellitus (DM2). Objective: To estimate the prevalence of PAD together with the associated factors in a sample of patients with DM2, treated in the Family Health Strategies (FHS) program, in the municipality of Pindamonhangaba, SP. Methods: Quantitative research in a cross-sectional study of 38 individuals who were diagnosed with DM2, between 40 and 77 years old, selected by convenience sampling and treated in the family health program in two different districts of the municipality. The method consisted of the evaluation of personal and anthropometric data, anamnesis and physical examination including the ankle-brachial index (ABI). Results: PAD was present in 21.1% (95%CI: 16.9 to 25.8) of the investigated population. Risk factors observed were age range of 51 to 69 years (75%), overweight (50%), systemic arterial hypertension (SAH) (100%), smoking (62.5%) and physical inactivity (87.5%). Conclusion: The prevalence of PAD was more than a fifth of those diagnosed with DM2, and the most prevalent associated risk factors were SAH, physical inactivity, smoking and overweight with and without PAD.
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Affiliation(s)
- Peter A Gottlieb
- From the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora
| | - Aaron W Michels
- From the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora
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Affiliation(s)
- Haobo Li
- Cardiovascular Research Center, Division of Cardiology, Corrigan Minehan Heart Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-2696
| | - Margaret H Hastings
- Cardiovascular Research Center, Division of Cardiology, Corrigan Minehan Heart Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-2696
| | - Anthony Rosenzweig
- Cardiovascular Research Center, Division of Cardiology, Corrigan Minehan Heart Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114-2696
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32
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Bock JM, Hughes WE, Ueda K, Feider AJ, Hanada S, Kruse NT, Iwamoto E, Casey DP. Greater α1-adrenergic-mediated vasoconstriction in contracting skeletal muscle of patients with type 2 diabetes. Am J Physiol Heart Circ Physiol 2020; 319:H797-H807. [DOI: 10.1152/ajpheart.00532.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Findings presented in this article are the first to show patients with type 2 diabetes mellitus have blunted hyperemic and vasodilatory responses to dynamic handgrip exercise. Moreover, we illustrate greater α1-adrenergic-mediated vasoconstriction may contribute to our initial observations. Collectively, these data suggest patients with type 2 diabetes may have impaired functional sympatholysis, which can contribute to their reduced exercise capacity.
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Affiliation(s)
- Joshua M. Bock
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - William E. Hughes
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Kenichi Ueda
- Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Andrew J. Feider
- Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Satoshi Hanada
- Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Nicholas T. Kruse
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Abboud Cardiovascular Research Center, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Erika Iwamoto
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Darren P. Casey
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Abboud Cardiovascular Research Center, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Fraternal Order of Eagles Diabetes Research Center, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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33
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Type 2 diabetes is an independent predictor of lowered peak aerobic capacity in heart failure patients with non-reduced or reduced left ventricular ejection fraction. Cardiovasc Diabetol 2020; 19:142. [PMID: 32950064 PMCID: PMC7502205 DOI: 10.1186/s12933-020-01114-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/12/2020] [Indexed: 12/13/2022] Open
Abstract
Background Although type 2 diabetes mellitus (T2DM) is one of the most frequent comorbidities in patients with chronic heart failure (CHF), the effects of T2DM on the exercise capacity of CHF patients are fully unknown. Here, we tested the hypothesis that the coexistence of T2DM lowers CHF patients’ peak aerobic capacity. Methods We retrospectively analyzed the cases of 275 Japanese CHF patients with non-reduced ejection fraction (left ventricular ejection fraction [LVEF] ≥ 40%) or reduced EF (LVEF < 40%) who underwent cardiopulmonary exercise testing. We divided them into diabetic and nondiabetic groups in each CHF cohort. Results The mean peak oxygen uptake (VO2) value was 16.87 mL/kg/min in the non-reduced LVEF cohort and 15.52 mL/kg/min in the reduced LVEF cohort. The peak VO2 was lower in the diabetics versus the nondiabetics in the non-reduced LVEF cohort with the mean difference (95% confidence interval [95% CI]) of − 0.93 (− 1.82 to − 0.04) mL/kg/min and in the reduced LVEF cohort with the mean difference of − 1.05 (− 1.96 to − 0.15) mL/kg/min, after adjustment for age-squared, gender, anemia, renal function, LVEF, and log B-type natriuretic peptide (BNP). The adjusted VO2 at anaerobic threshold (AT), a submaximal aerobic capacity, was also decreased in the diabetic patients with both non-reduced and reduced LVEFs. Intriguingly, the diabetic patients had a lower adjusted peak O2 pulse than the nondiabetic patients in the reduced LVEF cohort, but not in the non-reduced LVEF cohort. A multivariate analysis showed that the presence of T2DM was an independent predictor of lowered peak VO2 in CHF patients with non-reduced LVEF and those with reduced LVEF. Conclusions T2DM was associated with lowered peak VO2 in CHF patients with non-reduced or reduced LVEF. The presence of T2DM has a negative impact on CHF patients’ exercise capacity, and the degree of impact is partly dependent on their LV systolic function.
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Kumar A, Xie L, Ta CM, Hinton AO, Gunasekar SK, Minerath RA, Shen K, Maurer JM, Grueter CE, Abel ED, Meyer G, Sah R. SWELL1 regulates skeletal muscle cell size, intracellular signaling, adiposity and glucose metabolism. eLife 2020; 9:58941. [PMID: 32930093 PMCID: PMC7541086 DOI: 10.7554/elife.58941] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/07/2020] [Indexed: 12/26/2022] Open
Abstract
Maintenance of skeletal muscle is beneficial in obesity and Type 2 diabetes. Mechanical stimulation can regulate skeletal muscle differentiation, growth and metabolism; however, the molecular mechanosensor remains unknown. Here, we show that SWELL1 (Lrrc8a) functionally encodes a swell-activated anion channel that regulates PI3K-AKT, ERK1/2, mTOR signaling, muscle differentiation, myoblast fusion, cellular oxygen consumption, and glycolysis in skeletal muscle cells. LRRC8A over-expression in Lrrc8a KO myotubes boosts PI3K-AKT-mTOR signaling to supra-normal levels and fully rescues myotube formation. Skeletal muscle-targeted Lrrc8a KO mice have smaller myofibers, generate less force ex vivo, and exhibit reduced exercise endurance, associated with increased adiposity under basal conditions, and glucose intolerance and insulin resistance when raised on a high-fat diet, compared to wild-type (WT) mice. These results reveal that the LRRC8 complex regulates insulin-PI3K-AKT-mTOR signaling in skeletal muscle to influence skeletal muscle differentiation in vitro and skeletal myofiber size, muscle function, adiposity and systemic metabolism in vivo.
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Affiliation(s)
- Ashutosh Kumar
- Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, United States
| | - Litao Xie
- Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, United States
| | - Chau My Ta
- Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, United States
| | - Antentor O Hinton
- Fraternal Order of Eagles Diabetes Research Center, Iowa City, United States.,Division of Endocrinology and Metabolism, Iowa City, United States
| | - Susheel K Gunasekar
- Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, United States
| | - Rachel A Minerath
- Fraternal Order of Eagles Diabetes Research Center, Iowa City, United States.,Division of Cardiology, University of Iowa, Iowa City, United States
| | - Karen Shen
- Program in Physical Therapy and Departments of Neurology, Biomedical Engineering and Orthopedic Surgery, Washington University in St. Louis, St. Louis, United States
| | - Joshua M Maurer
- Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, United States
| | - Chad E Grueter
- Fraternal Order of Eagles Diabetes Research Center, Iowa City, United States.,Division of Cardiology, University of Iowa, Iowa City, United States
| | - E Dale Abel
- Fraternal Order of Eagles Diabetes Research Center, Iowa City, United States.,Division of Endocrinology and Metabolism, Iowa City, United States
| | - Gretchen Meyer
- Program in Physical Therapy and Departments of Neurology, Biomedical Engineering and Orthopedic Surgery, Washington University in St. Louis, St. Louis, United States
| | - Rajan Sah
- Department of Internal Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, United States
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Alahmari KA, Rengaramanujam K, Reddy RS, Samuel PS, Kakaraparthi VN, Ahmad I, Tedla JS. Cardiorespiratory Fitness as a Correlate of Cardiovascular, Anthropometric, and Physical Risk Factors: Using the Ruffier Test as a Template. Can Respir J 2020; 2020:3407345. [PMID: 32963643 PMCID: PMC7495241 DOI: 10.1155/2020/3407345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/23/2020] [Indexed: 11/18/2022] Open
Abstract
Background Assessment of cardiorespiratory fitness (CRF) is a standard procedure in routine clinical practices. Early identification of risk factors through screening is vital in the fight against chronic diseases. Evaluation of CRF can impose cost implications in the clinical setting; thus, a simple and easy-to-use test is to be advocated. The Ruffier test is a simple test that can assess CRF, and it is necessary to find whether the test reflects the effects of compounding factors in CRF. Objective This study aims to determine the association between CRF (estimated VO2max) with cardiovascular, anthropometric, and physical risk factors using the Ruffier test. Methods A cross-sectional study with a sample of 52 male participants was conducted. Before the Ruffier test, each participant's body weight, height, waist circumference, skinfold thickness, thigh length, lower-limb length, thigh circumference, physical activity, blood pressure, smoking, diabetes, and pulmonary functions were recorded, and these factors correlated with CRF. Results There was a significant inverse relationship found between the estimated VO2max and age, height, body weight, body mass index, waist circumference, a sum of skinfold, fat percentage, thigh length, lower-limb length, thigh circumference, smoking, blood pressure, heart rates, and diabetes (p < 0.05). A significant positive correlation was found between the estimated VO2max with physical activity and respiratory functions (p < 0.05). In the multivariable model, body weight and resting heart rate were significantly inversely associated with the estimated VO2max(p < 0.05). Conclusion Using the Ruffier test, various risk factors of CRF are correlated with the estimated VO2max. This test reflects the effects of different compounding factors on CRF; therefore, it can be used in routine clinical practices to identify the risk factors early.
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Affiliation(s)
- Khalid A. Alahmari
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Kanagaraj Rengaramanujam
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Paul Silvian Samuel
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Venkata Nagaraj Kakaraparthi
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Irshad Ahmad
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Jaya Shanker Tedla
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
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36
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Gulsin GS, Henson J, Brady EM, Sargeant JA, Wilmot EG, Athithan L, Htike ZZ, Marsh AM, Biglands JD, Kellman P, Khunti K, Webb D, Davies MJ, Yates T, McCann GP. Cardiovascular Determinants of Aerobic Exercise Capacity in Adults With Type 2 Diabetes. Diabetes Care 2020; 43:2248-2256. [PMID: 32680830 PMCID: PMC7440912 DOI: 10.2337/dc20-0706] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/09/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the relationship between subclinical cardiac dysfunction and aerobic exercise capacity (peak VO2) in adults with type 2 diabetes (T2D), a group at high risk of developing heart failure. RESEARCH DESIGN AND METHODS Cross-sectional study. We prospectively enrolled a multiethnic cohort of asymptomatic adults with T2D and no history, signs, or symptoms of cardiovascular disease. Age-, sex-, and ethnicity-matched control subjects were recruited for comparison. Participants underwent bioanthropometric profiling, cardiopulmonary exercise testing, and cardiovascular magnetic resonance with adenosine stress perfusion imaging. Multivariable linear regression analysis was undertaken to identify independent associations between measures of cardiovascular structure and function and peak VO2. RESULTS A total of 247 adults with T2D (aged 51.8 ± 11.9 years, 55% males, 37% black or south Asian ethnicity, HbA1c 7.4 ± 1.1% [57 ± 12 mmol/mol], and duration of diabetes 61 [32-120] months) and 78 control subjects were included. Subjects with T2D had increased concentric left ventricular remodeling, reduced myocardial perfusion reserve (MPR), and markedly lower aerobic exercise capacity (peak VO2 18.0 ± 6.6 vs. 27.8 ± 9.0 mL/kg/min; P < 0.001) compared with control subjects. In a multivariable linear regression model containing age, sex, ethnicity, smoking status, and systolic blood pressure, only MPR (β = 0.822; P = 0.006) and left ventricular diastolic filling pressure (E/e') (β = -0.388; P = 0.001) were independently associated with peak VO2 in subjects with T2D. CONCLUSIONS In a multiethnic cohort of asymptomatic people with T2D, MPR and diastolic function are key determinants of aerobic exercise capacity, independent of age, sex, ethnicity, smoking status, or blood pressure.
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Affiliation(s)
- Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K.
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Jack A Sargeant
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Emma G Wilmot
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, U.K
| | - Lavanya Athithan
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Zin Z Htike
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, U.K
| | - Anna-Marie Marsh
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | | | - Peter Kellman
- National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - David Webb
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester, U.K.
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37
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Miyamoto T, Watanabe K, Fukuda K, Moritani T. Near-infrared Spectroscopy of Vastus Lateralis Muscle during Incremental Cycling Exercise in patients with Type 2 Diabetes. Phys Ther Res 2020; 23:23-30. [PMID: 32850275 DOI: 10.1298/ptr.e9984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/21/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE It is clinically important to elucidate the precise mechanism of exercise intolerance in patients with type 2 diabetes (T2DM). The aim of this study was to examine whether there is a difference in the time course change of the oxygenation in the vastus lateralis (VL) muscle during submaximal incremental cycling exercise between patients with T2DM and age-matched healthy subjects. METHODS Nine elderly men with T2DM and 10 age-matched healthy men (CON) participated in this study. All participants performed an incremental cycling exercise.Total, deoxygenated and oxygenated hemoglobin/myoglobin in the VL muscle were assessed using near-infrared spectroscopy, and cardiorespiratory response was also evaluated during the exercise. RESULTS There were no significant differences in the time course changes of deoxygenated hemoglobin/myoglobin between groups ( p > 0.05). However, the oxygenated hemoglobin/myoglobin in T2DM was significantly higher than that in CON at an intensity above ventilatory threshold during the incremental cycling exercise ( p< 0.05). CONCLUSION This study suggests that patients with T2DM had early limitation of oxygen extraction and lower capacity of oxygenated myoglobin dissociation in the VL muscle. The fact that patients with T2DM showed different oxygen kinetics in a peripheral tissue from healthy subjects may partly explain the potential mechanisms of exercise intolerance in T2DM.
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Affiliation(s)
| | - Kohei Watanabe
- School of International Liberal Studies, Chukyo University
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38
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Bozdemir-Ozel C, Arikan H, Calik-Kutukcu E, Karadüz BN, Inal-Ince D, Kabakci G, Sumer E, Dagdelen S. Subclinical Inflammation Is Associated With Reductions in Muscle Oxygenation, Exercise Capacity and Quality of Life in Adults With Type 2 Diabetes. Can J Diabetes 2020; 44:422-427. [PMID: 32616275 DOI: 10.1016/j.jcjd.2020.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 02/13/2020] [Accepted: 02/28/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Exercise capacity is related to both morbidity and mortality in patients with type 2 diabetes (T2DM). The aim of this study was to investigate the relationship between subclinical inflammation level, exercise capacity, muscle oxygenation and quality of life in T2DM. METHODS This study includes 28 patients with T2DM (mean age, 51.5±5.0 years; male-to-female ratio, 6:22). Exercise capacity was evaluated using an incremental symptom-limited maximal exercise test on a bicycle ergometer. Muscle oxygenation was investigated using a wearable lactate-measuring device. Diabetes-specific quality of life was assessed using the Diabetes Quality of Life Questionnaire (DQOL). Subclinical inflammation was assessed using C-reactive protein (CRP) levels. RESULTS CRP level was negatively correlated with peak workload during the test (r=-0.588, p=0.002), muscle oxygenation (r=-0.465, p=0.019) and the psychological impact of treatment subscale of the DQOL (r=-0.540, p=0.017), and positively correlated with body mass index (r=0.519, p=0.008), waist circumference (r=0.426, p=0.038) and fat percentage (r=0.573, p=0.004). There was no correlation between CRP and fasting blood glucose or glycated hemoglobin level (p>0.05). Peak workload was inversely related to fat percentage (r=-0.467, p=0.016) and the DQOL worry about the future impact of diabetes subscale (r=-0.501, p=0.021). CONCLUSIONS In our study, subclinical inflammation negatively affected muscle oxygenation, exercise capacity and quality of life independently of glycemic indicators. Our findings suggest that the degree of glycemic control is insufficient to explain lower exercise capacity. Further studies are needed to investigate subclinical inflammation-reducing interventions in T2DM.
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Affiliation(s)
- Cemile Bozdemir-Ozel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Hülya Arikan
- Faculty of Health Sciences, Department of Physiotherapy, Atılım University, Ankara, Turkey
| | - Ebru Calik-Kutukcu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Beyza Nur Karadüz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Deniz Inal-Ince
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Giray Kabakci
- Department of Cardiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Erkan Sumer
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Selçuk Dagdelen
- Department of Endocrinology and Metabolism, School of Medicine, Hacettepe University, Ankara, Turkey
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Kunimoto M, Shimada K, Yokoyama M, Matsubara T, Aikawa T, Ouchi S, Shimizu M, Fukao K, Miyazaki T, Kadoguchi T, Fujiwara K, Abulimiti A, Honzawa A, Yamada M, Shimada A, Yamamoto T, Asai T, Amano A, Smit AJ, Daida H. Association between the tissue accumulation of advanced glycation end products and exercise capacity in cardiac rehabilitation patients. BMC Cardiovasc Disord 2020; 20:195. [PMID: 32326893 PMCID: PMC7178950 DOI: 10.1186/s12872-020-01484-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background Advanced glycation end products (AGEs) are associated with aging, diabetes mellitus (DM), and other chronic diseases. Recently, the accumulation of AGEs can be evaluated by skin autofluorescence (SAF). However, the relationship between SAF levels and exercise capacity in patients with cardiovascular disease (CVD) remains unclear. This study aimed to investigate the association between the tissue accumulation of AGEs and clinical characteristics, including exercise capacity, in patients with CVD. Methods We enrolled 319 consecutive CVD patients aged ≥40 years who underwent early phase II cardiac rehabilitation (CR) at our university hospital between November 2015 and September 2017. Patient background, clinical data, and the accumulation of AGEs assessed by SAF were recorded at the beginning of CR. Characteristics were compared between two patient groups divided according to the median SAF level (High SAF and Low SAF). Results The High SAF group was significantly older and exhibited a higher prevalence of DM than the Low SAF group. The sex ratio did not differ between the two groups. AGE levels showed significant negative correlations with peak oxygen uptake and ventilator efficiency (both P < 0.0001). Exercise capacity was significantly lower in the high SAF group than in the low SAF group, regardless of the presence or absence of DM (P < 0.05). A multivariate logistic regression analysis showed that SAF level was an independent factor associated with reduced exercise capacity (odds ratio 2.10; 95% confidence interval 1.13–4.05; P = 0.02). Conclusion High levels of tissue accumulated AGEs, as assessed by SAF, were significantly and independently associated with reduced exercise capacity. These data suggest that measuring the tissue accumulation of AGEs may be useful in patients who have undergone CR, irrespective of whether they have DM.
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Affiliation(s)
- Mitsuhiro Kunimoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. .,Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Miho Yokoyama
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tomomi Matsubara
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tatsuro Aikawa
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shohei Ouchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Megumi Shimizu
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kosuke Fukao
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tetsuro Miyazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tomoyasu Kadoguchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kei Fujiwara
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Abidan Abulimiti
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Akio Honzawa
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Miki Yamada
- Cardiovascular Rehabilitation and Fitness, Juntendo University Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Akie Shimada
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Andries J Smit
- Division of Vascular Medicine, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, Netherlands
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Faculty of Health Science, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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40
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Santos-de-Araújo AD, Bassi-Dibai D, Veiga TP, Caruso FCR, Mendes RG, Júnior JCB, Arena R, Schwartzmann PV, Simões RP, Borghi-Silva A. Circulatory and ventilatory power in diabetic patients: Secondary analysis of a randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1830. [PMID: 31883223 DOI: 10.1002/pri.1830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/03/2019] [Accepted: 12/13/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Circulatory (CP) and ventilatory power (VP) have been used to improve the prognostic accuracy of cardiopulmonary exercise tests in cardiovascular disease, such as coronary artery disease. However, the effects of combined resistance and aerobic exercise program on VP and CP, especially in type 2 diabetes patients, have not been adequately investigated. Thus, this new parameter can be useful to prescribe exercise programs more assertive for this population. The present study aimed to assess the effect of 3 months of combined resistance and aerobic exercise training (CET) on CP and VP in patients with type 2 diabetes. METHODS A randomized controlled trial was conducted involving 48 diabetic patients with an average age of 52.4 (±8.01) years old. The subjects were randomized into two groups: sedentary (SG, n = 15) and the CET group (n = 19). Cardiopulmonary exercise testing (symptom-limited incremental) was performed on a cycle ergometer, and the following parameters were measured: relative VO2 , VE /VCO2 slope, linear relationship between oxygen uptake and minute ventilation, and VCO2 . CET was performed with 30-min aerobic and 30-min resistance exercises three times a week for 12 weeks. RESULTS Significant (p < .05) and clinical (d ≥ .80) differences were observed that favoured CET compared with SG for the following variables: heart rate, workload, VO2 relative peak, circulatory power peak, and VCO2 peak. Although no statistical difference was observed for ventilatory power, there was a clinical difference (p > .05 and d ≥ 0.80) that favoured CET. CONCLUSION Three months of combined exercise training improved VP and CP indices in patients with type 2 diabetes when compared with a sedentary group.
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Affiliation(s)
| | - Daniela Bassi-Dibai
- Postgraduate Program in Management and Health Services, Ceuma University, São Luís, Brazil
| | - Thalita Pereira Veiga
- Postgraduate Program in Management and Health Services, Ceuma University, São Luís, Brazil
| | | | - Renata Gonçalves Mendes
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos, São Carlos, Brazil
| | | | - Ross Arena
- Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois
| | | | - Rodrigo Polaquini Simões
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos, São Carlos, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos, São Carlos, Brazil
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41
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Lewis MT, Kasper JD, Bazil JN, Frisbee JC, Wiseman RW. Quantification of Mitochondrial Oxidative Phosphorylation in Metabolic Disease: Application to Type 2 Diabetes. Int J Mol Sci 2019; 20:E5271. [PMID: 31652915 PMCID: PMC6862501 DOI: 10.3390/ijms20215271] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 12/17/2022] Open
Abstract
Type 2 diabetes (T2D) is a growing health concern with nearly 400 million affected worldwide as of 2014. T2D presents with hyperglycemia and insulin resistance resulting in increased risk for blindness, renal failure, nerve damage, and premature death. Skeletal muscle is a major site for insulin resistance and is responsible for up to 80% of glucose uptake during euglycemic hyperglycemic clamps. Glucose uptake in skeletal muscle is driven by mitochondrial oxidative phosphorylation and for this reason mitochondrial dysfunction has been implicated in T2D. In this review we integrate mitochondrial function with physiologic function to present a broader understanding of mitochondrial functional status in T2D utilizing studies from both human and rodent models. Quantification of mitochondrial function is explained both in vitro and in vivo highlighting the use of proper controls and the complications imposed by obesity and sedentary lifestyle. This review suggests that skeletal muscle mitochondria are not necessarily dysfunctional but limited oxygen supply to working muscle creates this misperception. Finally, we propose changes in experimental design to address this question unequivocally. If mitochondrial function is not impaired it suggests that therapeutic interventions and drug development must move away from the organelle and toward the cardiovascular system.
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Affiliation(s)
- Matthew T Lewis
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA.
| | - Jonathan D Kasper
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA.
- Present address: Molecular Physiology Institute, Duke University, Durham, NC 27701, USA.
| | - Jason N Bazil
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA.
| | - Jefferson C Frisbee
- Department of Medical Biophysics, University of Western Ontario, London, ON N6A 3K7, Canada.
| | - Robert W Wiseman
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA.
- Department of Radiology, Michigan State University, East Lansing, MI 48824, USA.
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42
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Gallé F, Di Onofrio V, Miele A, Belfiore P, Liguori G. Effects of a community-based exercise and motivational intervention on physical fitness of subjects with type 2 diabetes. Eur J Public Health 2019; 29:281-286. [PMID: 30052924 DOI: 10.1093/eurpub/cky140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study aimed to analyze the effects of a long-term community-based combined exercise program consisting of aerobic, resistance, flexibility and agility/balance training associated with motivational interviewing on physical fitness, physiological parameters and Physical Activity (PA) levels in middle-aged and older patients with Type 2 Diabetes (T2D). METHODS Sixty-nine diabetic subjects (mean age 63 ± 5.2 y, 62.3% M) underwent a 9-month exercise program and 12 motivational group meetings focused on PA, while 90 diabetic controls (mean age 64 ± 6.4 y, 58% M) underwent usual PA recommendations. Changes in physical fitness measured by Senior Fitness Tests, BMI, HbA1c, waist circumference (WC) and habitual PA expressed in Metabolic Equivalent of Tasks (METs)-min/week were evaluated in each group through the International PA Questionnaire and compared between groups. RESULTS At the end of the intervention participants showed significant improvements in BMI (29.3 to 27.6 kg/m2, P < 0.03), HbA1c (6.5 to 6.1%, P < 0.01), WC (104.2 to 95.6 cm, P < 0.01) and all the physical fitness parameters (P < 0.01) but lower body flexibility (P = 0.82), while only upper body strength (P = 0.04) and agility (P ≤ 0.01) improved significantly in controls. Habitual PA increased in participants and controls (+67 and +19 METs-min/week, respectively, P ≤ 0.01). Changes in physical fitness and PA levels registered in the two groups differed significantly (P < 0.01), while improvements in BMI, HbA1c and WC did not (P = 0.40, P = 0.52, P = 0.05, respectively). CONCLUSIONS A long-term motivational exercise-based intervention may be more effective than PA recommendations only in improving physical fitness and PA levels in individuals with T2D and produce similar health improvements.
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Affiliation(s)
- Francesca Gallé
- Department of Movement Sciences and Wellbeing, University of Naples 'Parthenope', Naples, Italy
| | - Valeria Di Onofrio
- Department of Sciences and Technologies, University of Naples 'Parthenope', Naples, Italy
| | - Alessandra Miele
- Department of Movement Sciences and Wellbeing, University of Naples 'Parthenope', Naples, Italy
| | - Patrizia Belfiore
- Department of Movement Sciences and Wellbeing, University of Naples 'Parthenope', Naples, Italy
| | - Giorgio Liguori
- Department of Movement Sciences and Wellbeing, University of Naples 'Parthenope', Naples, Italy
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Bastien M, Poirier P, Brassard P, Arsenault BJ, Bertrand OF, Després JP, Costerousse O, Piché ME. Effect of PPARγ agonist on aerobic exercise capacity in relation to body fat distribution in men with type 2 diabetes mellitus and coronary artery disease: a 1-yr randomized study. Am J Physiol Endocrinol Metab 2019; 317:E65-E73. [PMID: 30964707 DOI: 10.1152/ajpendo.00505.2018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Targeting metabolic determinants of exercise performance with pharmacological agents that would mimic/potentiate the effects of exercise represents an attractive clinical alternative to counterbalance the poor exercise capacity in patients with type 2 diabetes mellitus (T2DM). We examined the effect of 1-yr treatment with the insulin sensitizer peroxisome proliferator-activated receptor (PPAR)γ agonist rosiglitazone on aerobic exercise capacity and body fat composition/distribution in men with T2DM and stable coronary artery disease (CAD). One-hundred four men (age: 64 ± 7 yr; body mass index: 30.0 ± 4.4 kg/m2) with T2DM and CAD were randomized to receive rosiglitazone or placebo for 1 yr. Aerobic exercise capacity (exercise duration) was assessed with a maximal treadmill test, and body composition/distribution were assessed by dual-energy X-ray absorptiometry/computed tomography scans. At 1 yr, patients with T2DM under PPARγ agonist treatment showed a reduction in aerobic exercise capacity compared with the control group (exercise duration change, -31 ± 8 versus 7 ± 11 s, P = 0.009). Significant increases in body fat mass (3.1 ± 0.4 kg, 12%), abdominal and mid-thigh subcutaneous adipose tissue (AT) levels, and mid-thigh skeletal muscle fat were found (all P < 0.01), whereas no effect on visceral AT levels was observed (P > 0.05) under treatment. Subcutaneous fat mass gained under PPARγ agonist was the strongest predictor of the worsening in aerobic exercise capacity (P > 0.0001); no association was found with skeletal muscle fat infiltration nor visceral AT. Treatment with the insulin sensitizer PPARγ agonist rosiglitazone in patients with T2DM and CAD is associated with a worsening in aerobic exercise capacity, which seems to be mainly attributable to weight gain and subcutaneous fat mass expansion.
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Affiliation(s)
- Marjorie Bastien
- Quebec Heart and Lung Institute, Laval University , Quebec , Canada
| | - Paul Poirier
- Quebec Heart and Lung Institute, Laval University , Quebec , Canada
- Faculty of Pharmacy, Laval University , Quebec , Canada
| | - Patrice Brassard
- Quebec Heart and Lung Institute, Laval University , Quebec , Canada
- Faculty of Medicine, Department of Kinesiology, Laval University , Quebec , Canada
| | - Benoit J Arsenault
- Quebec Heart and Lung Institute, Laval University , Quebec , Canada
- Faculty of Medicine, Department of Medicine, Laval University , Quebec , Canada
| | | | - Jean-Pierre Després
- Quebec Heart and Lung Institute, Laval University , Quebec , Canada
- Faculty of Medicine, Department of Kinesiology, Laval University , Quebec , Canada
| | | | - Marie-Eve Piché
- Quebec Heart and Lung Institute, Laval University , Quebec , Canada
- Faculty of Medicine, Department of Medicine, Laval University , Quebec , Canada
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Roberts TJ, Burns AT, MacIsaac RJ, MacIsaac AI, Prior DL, La Gerche A. Sildenafil enhances central hemodynamic responses to exercise, but not V̇o 2peak, in people with diabetes mellitus. J Appl Physiol (1985) 2019; 127:1-10. [PMID: 31046521 PMCID: PMC6692740 DOI: 10.1152/japplphysiol.00947.2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 11/22/2022] Open
Abstract
Exercise capacity is frequently reduced in people with diabetes mellitus (DM), and the contribution of pulmonary microvascular dysfunction remains undefined. We hypothesized that pulmonary microvascular disease, measured by a novel exercise echocardiography technique termed pulmonary transit of agitated contrast (PTAC), would be greater in subjects with DM and that the use of pulmonary vasodilator agent sildenafil would improve exercise performance by reducing right ventricular afterload. Forty subjects with DM and 20 matched controls performed cardiopulmonary exercise testing and semisupine exercise echocardiography 1 h after placebo or sildenafil ingestion in a double-blind randomized crossover design. The primary efficacy end point was exercise capacity (V̇o2peak) while secondary measures included pulmonary vascular resistance, cardiac output, and change in PTAC. DM subjects were aged 44 ± 13 yr, 73% male, with 16 ± 10 yr DM history. Sildenafil caused marginal improvements in echocardiographic measures of biventricular systolic function in DM subjects. Exercise-induced increases in pulmonary artery systolic pressure and pulmonary vascular resistance were attenuated with sildenafil, while heart rate (+2.4 ±1.2 beats/min, P = 0.04) and cardiac output (+322 ± 21 ml, P = 0.03) improved. However, the degree of PTAC did not change (P = 0.93) and V̇o2peak did not increase following sildenafil as compared with placebo (V̇o2peak: 31.8 ± 9.7 vs. 32.1 ± 9.5 ml·min-1·kg-1, P = 0.42). We conclude that sildenafil administration causes modest acute improvements in central hemodynamics but does not improve exercise capacity. This may be due to the mismatch in action of sildenafil on the pulmonary arteries rather than the distal pulmonary microvasculature and potential adverse effects on peripheral oxygen extraction. NEW & NOTEWORTHY This is one of the largest and most comprehensive studies of cardiopulmonary exercise performance in people with diabetes mellitus and to our knowledge the first to assess the effect of sildenafil using detailed echocardiographic measures during incremental exercise. Sildenafil attenuated the rise in pulmonary vascular resistance while augmenting cardiac output and intriguingly heart rate, without conferring any improvement in exercise capacity. The enhanced central hemodynamic indexes may have been offset by reduced peripheral O2 extraction.
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Affiliation(s)
- Timothy J Roberts
- Department of Cardiology, St. Vincent's Hospital Melbourne , Fitzroy , Australia
- St. Vincent's Department of Medicine, University of Melbourne , Fitzroy , Australia
| | - Andrew T Burns
- Department of Cardiology, St. Vincent's Hospital Melbourne , Fitzroy , Australia
- St. Vincent's Department of Medicine, University of Melbourne , Fitzroy , Australia
| | - Richard J MacIsaac
- St. Vincent's Department of Medicine, University of Melbourne , Fitzroy , Australia
- Department of Endocrinology and Diabetes, St. Vincent's Hospital Melbourne , Fitzroy , Australia
| | - Andrew I MacIsaac
- Department of Cardiology, St. Vincent's Hospital Melbourne , Fitzroy , Australia
- St. Vincent's Department of Medicine, University of Melbourne , Fitzroy , Australia
| | - David L Prior
- Department of Cardiology, St. Vincent's Hospital Melbourne , Fitzroy , Australia
- St. Vincent's Department of Medicine, University of Melbourne , Fitzroy , Australia
- National Centre for Sports Cardiology, Fitzroy , Australia
| | - André La Gerche
- Department of Cardiology, St. Vincent's Hospital Melbourne , Fitzroy , Australia
- St. Vincent's Department of Medicine, University of Melbourne , Fitzroy , Australia
- National Centre for Sports Cardiology, Fitzroy , Australia
- Baker Heart and Diabetes Institute , Melbourne , Australia
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Zhu HT, Yu M, Hu H, He QF, Pan J, Hu RY. Factors associated with glycemic control in community-dwelling elderly individuals with type 2 diabetes mellitus in Zhejiang, China: a cross-sectional study. BMC Endocr Disord 2019; 19:57. [PMID: 31170961 PMCID: PMC6555723 DOI: 10.1186/s12902-019-0384-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/24/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although exercise seems to be beneficial for type 2 diabetes mellitus (T2DM) patients, there is limited research elucidating the optimal accessible indices of adiposity and insulin resistance for identifying elderly T2DM patients with poor glycemic control, which could be improved by performing regular exercise. METHODS A community-based, cross-sectional study was conducted with 918 Chinese elderly individuals with T2DM in Zhejiang. Relevant risk factors for poor glycemic control, as determined using glycated haemoglobin A1c (HbA1c) > 7%, were explored using logistic regression analyses and included body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), fasting blood glucose (FBG), triglycerides (TGs), total cholesterol (TC), the product of fasting triglycerides and glucose (TyG), visceral adiposity index (VAI), lipid accumulation product (LAP), TyG-BMI, and TyG-WC. Comparisons of the risk factors' ability to discriminate poor glycemic control as well as their optimal cutoff values were determined using receiver operating characteristic (ROC) analyses, and then the extent of poor glycemic control risk reduction through regular exercise was examined using multivariate logistic regression analyses. RESULTS The overall poor glycemic control rate was 49.3%. The factors associated with poor glycemic control included FBG > 3.869, TyG > 8.73, TyG-BMI > 222.45, and TyG-WC > 713.48 in logistic regression analyses. The optimal cutoff points of FBG, TyG, TyG-WC, and TyG-BMI in discriminating poor glycemic control were 7.38, 9.22, 813.33, and 227.77, and their corresponding areas under the ROC curves were 0.864(0.840-0.886), 0.684(0.653-0.714), 0.604(0.571-0.635), and 0.574(0.541-0.606), respectively. Occasional and regular exercise reduced the odds ratios (95% confidence interval) of poor glycemic control to 0.187 (0.063-0.557) and 0.183 (0.059-0.571) for subjects with TyG-WC > 813.33 (p = 0.008), to 0.349 (0.156-0.782) and 0.284 (0.123-0.652) for subjects with TyG > 9.22 (p = 0.011), and to 0.390 (0.175-0.869) and 0.300(0.130-0.688) for subjects with TyG-BMI > 227.77 (p = 0.017), respectively, after adjusting for multiple confounding factors. CONCLUSION Among elderly individuals with T2DM, poor glycemic control risk might be identified using indices calculated from FBG, TG, BMI, and WC measurements, which are indicative of adiposity and insulin resistance. TyG-WC seems to be an accessible and useful indicator to identify which elderly T2DM patients would benefit from performing regular exercise to achieve good glycemic control.
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Affiliation(s)
- Hong-Ting Zhu
- Yongkang Municipal Center for Disease Control and Prevention, Jinghua, Zhejiang, 321300 China
| | - Min Yu
- Department of Occupational Diseases, Zhejiang Academy of Medical Sciences, Zhejiang, 310013 Hangzhou China
| | - Hao Hu
- Yongkang Municipal Center for Disease Control and Prevention, Jinghua, Zhejiang, 321300 China
| | - Qing-Fang He
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng Road, Zhejiang, 310051 Hangzhou China
| | - Jin Pan
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng Road, Zhejiang, 310051 Hangzhou China
| | - Ru-Ying Hu
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng Road, Zhejiang, 310051 Hangzhou China
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Huber J, Smeikal M, Saely CH, Stingl H, Lechleitner M, Fasching P. Geriatrische Aspekte bei Diabetes mellitus (Update 2019). Wien Klin Wochenschr 2019; 131:236-245. [DOI: 10.1007/s00508-019-1463-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vukomanovic V, Suzic-Lazic J, Celic V, Cuspidi C, Petrovic T, Ilic S, Skokic D, Armando Morris D, Tadic M. Association between functional capacity and heart rate variability in patients with uncomplicated type 2 diabetes. Blood Press 2019; 28:184-190. [DOI: 10.1080/08037051.2019.1586431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Vladan Vukomanovic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
| | - Jelena Suzic-Lazic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
| | - Vera Celic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy
| | - Tijana Petrovic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
| | - Sanja Ilic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
| | - Dusan Skokic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
| | - Daniel Armando Morris
- Department of Internal Medicine and, Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Marijana Tadic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia
- Department of Internal Medicine and, Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Can an Exercise-Based Educational and Motivational Intervention be Durably Effective in Changing Compliance to Physical Activity and Anthropometric Risk in People with Type 2 Diabetes? A Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050701. [PMID: 30818773 PMCID: PMC6427192 DOI: 10.3390/ijerph16050701] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/13/2019] [Accepted: 02/22/2019] [Indexed: 01/02/2023]
Abstract
AIMS A nine-month motivational exercise-based intervention was previously offered to subjects with type 2 diabetes (T2D). A year after the end of the intervention, compliance to physical activity (PA) and anthropometric indices of participants were analyzed to evaluate the durability of its effects. METHODS PA levels, expressed as total energy expenditure per week, were assessed with the International Physical Activity Questionnaire (IPAQ). Changes in Body Mass Index (BMI), A Body Shape Index (ABSI), Hip Index (HI) z-scores, the relative mortality risk related to each of these measures, and a combined Anthropometric Risk Index (ARI) were also evaluated. RESULTS Of a total of the 52 subjects examined (67.9% males, mean age 61.8 ± 6.0), 46 (88.4%) were still sufficiently active as defined by IPAQ thresholds at follow-up. PA levels, anthropometric indices and related risks improved at follow-up in respect to the baseline and to the end of the intervention, although only PA levels, BMI and related measures, and ARI risk changed significantly. Habitual PA increased significantly after the intervention (p < 0.01) and this increase correlated with changes in BMI z-scores (r = -0.29, p = 0.04). BMI risk was significantly lower (p < 0.01) in participants still active at follow-up. CONCLUSIONS This study testifies to the persistence of compliance to PA and health benefits of a combined exercise-based and motivational intervention in subjects with T2D.
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Shaw A, Houghton D, Hallsworth K, Jakovljevic DG, Trenell MI, Cassidy S. Adiposity predicts low cardiorespiratory fitness in individuals with metabolic diseases. Diabetes Res Clin Pract 2018; 146:300-304. [PMID: 30391504 DOI: 10.1016/j.diabres.2018.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/28/2018] [Accepted: 10/29/2018] [Indexed: 01/25/2023]
Abstract
Cardiorespiratory fitness (CRF) is impaired in those with metabolic diseases and strongly predicts mortality. We found that adiposity, not glycaemic control or disease type, is the strongest predictor of low CRF in those with metabolic diseases. We discuss how adiposity and metabolic health may relate to outcomes in obesity.
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Affiliation(s)
- Andy Shaw
- Institute of Cellular Medicine, William Leech Building, Medical School, Newcastle University, Newcastle Upon Tyne, UK
| | - David Houghton
- Institute of Cellular Medicine, William Leech Building, Medical School, Newcastle University, Newcastle Upon Tyne, UK
| | - Kate Hallsworth
- Institute of Cellular Medicine, William Leech Building, Medical School, Newcastle University, Newcastle Upon Tyne, UK; The Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Djordje G Jakovljevic
- Institute of Cellular Medicine, William Leech Building, Medical School, Newcastle University, Newcastle Upon Tyne, UK
| | - Michael I Trenell
- NIHR Innovation Observatory, Newcastle University, Newcastle Upon Tyne, UK
| | - Sophie Cassidy
- Institute of Cellular Medicine, William Leech Building, Medical School, Newcastle University, Newcastle Upon Tyne, UK.
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Vounzoulaki E, Dipla K, Kintiraki E, Triantafyllou A, Grigoriadou I, Koletsos N, Zafeiridis A, Goulis DG, Douma S. Pregnancy and post-partum muscle and cerebral oxygenation during intermittent exercise in gestational diabetes: A pilot study. Eur J Obstet Gynecol Reprod Biol 2018; 232:54-59. [PMID: 30468984 DOI: 10.1016/j.ejogrb.2018.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/10/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This pilot, prospective, observational, cohort study aimed to examine, for the first time, the in vivo alterations in the oxygenation of the forearm skeletal muscles and the prefrontal lobes during intermittent exercise in women diagnosed with gestational diabetes mellitus (GDM), during and after pregnancy. STUDY DESIGN Nine pregnant women, diagnosed with GDM, performed a 3-min intermittent handgrip exercise protocol (at 35% of Maximal Voluntary Contraction) during pregnancy (mean 27th gestational week) and following labor (mean 71 weeks). During the protocol, muscle and cerebral oxygenation were assessed with near-infrared spectroscopy. Resting vascular parameters [carotid intima-media thickness (cIMT) and hemodynamic parameters (using rheocardiography)], and hematological/biochemical parameters during pregnancy and after delivery have been compared. RESULTS Although changes were observed in certain hematological parameters (p< 0.05), cIMT and hemodynamic parameters were not altered post-partum. In addition, both muscle and cerebral oxygenation parameters during handgrip were not significantly altered post-partum. CONCLUSIONS Despite significant changes in specific hematological parameters in women with GDM, impairments in muscle and cerebral oxygenation during exercise remained at one year after labor. These results indicate that alterations in vascular parameters and muscle/cerebral oxygenation associated with GDM do not entirely reverse post-partum. Future studies are needed to examine which interventions will lead to improvements in microvascular parameters and prevent type 2 diabetes.
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Affiliation(s)
- Elpida Vounzoulaki
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece.
| | - Konstantina Dipla
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Greece
| | - Evangelia Kintiraki
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Areti Triantafyllou
- Third Department of Internal Medicine, Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Iris Grigoriadou
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Greece
| | - Nikolaos Koletsos
- Third Department of Internal Medicine, Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Andreas Zafeiridis
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Stella Douma
- Third Department of Internal Medicine, Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
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